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Declaration for Mental Health Treatment - Illinois

Illinois · Fillable PDF · Free

This Illinois declaration lets you decide in advance whether you want psychotropic medication, electroconvulsive treatment, or short-term admission to a facility if a mental health crisis leaves you unable to decide, and lets you name someone to decide for you. This Illinois declaration lets you decide in advance whether you want psychotropic medication, electroconvulsive treatment, or short-term admission to a facility if a mental health crisis leaves you unable to decide, and lets you name someone to decide for you.

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Who this form is for

Illinois residents and families reviewing declaration for mental health treatment instructions.

What you'll need

Read the original packet’s instructions and complete only the fields that apply.
Bring acceptable identification and follow the packet’s signature and witness instructions.

How to complete it

Read the Notice (Pages 5–6) The Notice at the end explains what this declaration does and how long it lasts. Read it before you fill in anything.
Make your choices (Pages 1–2) For each treatment, initial whether you consent or do not consent, and add any conditions. You may choose a physician to help decide whether you are incapable.
Name an attorney-in-fact (Page 3, optional) Name a trusted adult to make these decisions for you, plus an alternate. Each must sign the acceptance on Page 4 for the appointment to work.
Sign with two witnesses (Page 3) Illinois requires two adult witnesses who know you personally. They cannot be your attorney-in-fact, your doctor or mental health provider, or a relative. We can provide qualified witnesses for an additional fee, and we recommend adding the notary acknowledgment on Page 4.

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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