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Connecticut PC-370: Physician's Evaluation

A Connecticut probate court may ask a physician to complete this evaluation in an involuntary proceeding to appoint a conservator of the person or estate, or in a review of an existing conservatorship. It asks whether the patient's capacity to make financial or personal decisions is impaired, the condition and diagnosis behind it, the effects on medical care, safe housing, finances and safety, and current medications and treatment needs.

Who completes it

A physician licensed in Connecticut who personally examined the patient on the stated date completes and signs the entire form, noting whether they are a practicing psychiatrist and whether they treat or only evaluated the patient.

Submitting and payment

How to submit it
File it with the probate court that requested it as a confidential document. Type or print in ink, and use form PC-180 or additional sheets for more space.

Good to know

  • If either capacity question is answered yes, complete all sections and give specific examples from recent history known to you.
  • Section 1a options are mental illness, cognitive deficiency, physical illness or disability, addiction, or other, resulting in inability to receive or evaluate information or communicate decisions.
  • Section 5 applies only to a review under C.G.S. 45a-660: state whether the conservatorship should be continued, modified or terminated, with reasons.
  • C.G.S. 45a-650 requires medical evidence from a physician who examined the respondent within 45 days for an involuntary conservatorship. Current edition PC-370 REV. 4/19.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Evaluation/Conservatorship

Official pagePDF

How this list is checked

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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Frequently asked questions

Who can complete Connecticut form PC-370?

A physician licensed to practice medicine in Connecticut who personally examined the patient on the date of examination entered on the form. The physician certifies both points when signing and gives a Connecticut medical license number and whether they are a practicing psychiatrist.

Is there a version for psychologists?

For respondents with intellectual disability, Connecticut uses a separate form, PC-372, completed by a licensed psychologist. PC-370 itself must be completed by a Connecticut-licensed physician who personally examined the respondent.

What does PC-370 ask about medications and treatment?

Section 2 asks you to list all prescribed medications, whether the patient can manage them, and whether any affect mental functioning. Section 3 asks whether hospitalization or other treatment is needed and whether the patient can weigh its benefits and risks.