Mental Health Conservatorship Petition

Petitioner Information

Name Address Phone Relationship to Proposed Conservatee

Proposed Conservatee Information

Name Date of Birth Address

Grounds for Conservatorship

Describe the facts and circumstances that demonstrate the individual is gravely disabled as a result of a mental health disorder and in need of care, treatment, or control.

Describe any less restrictive alternatives considered (if any):

Proposed treatment plan or recommendations (if any):

Signature

Date Petitioner's Signature