In Colorado, an intervening professional or peace officer completes this application to take a person into custody for up to 72 hours of treatment and evaluation when the person appears to have a mental health disorder and, as a result, to be an imminent danger to self or others or gravely disabled. It documents presenting symptoms, orientation, access to weapons and a narrative supporting probable cause.
The intervening professional or peace officer completes and signs the whole form, with title, agency and Colorado license or badge number; a co-signer line is provided. The individual does not complete any part.
Download the current version from the source each time; forms change without notice.
Emergency Hold Application
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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An intervening professional, such as a physician, physician assistant, psychologist, advanced practice registered nurse, licensed clinical social worker, licensed professional counselor, marriage and family therapist or licensed addiction counselor, or a peace officer. The signer lists their title, agency and license or badge number.
The form's notice to the individual, citing C.R.S. 27-65-106(5), states that the time for evaluation and treatment may not exceed 72 hours. The facility documents its evaluation on form M-11 to decide on release, voluntary treatment or certification.
The Colorado Behavioral Health Administration publishes fillable M-forms in a public Google Drive folder linked from its M-forms page at bha.colorado.gov. The current edition is Rev. 07/2026, and a single-page version of the M-1 is also posted.