Form 26.0 - Petition For Involuntary Treatment For Alcohol And Other Drug Abuse
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3PROBATE COURT OF ________________ COUNTY, OHIO
_____________, JUDGE
IN THE INTEREST OF: ______________________________________________________
CASE NO. __________
PETITION FOR INVOLUNTARY TREATMENT FOR
ALCOHOL AND OTHER DRUG ABUSE
[R.C. 5119.93]
RESPONDENT’S Residence Address: __________________________________________
RESPONDENT’S Current Location (if different): ___________________________________
PETITIONER: ______________________________________________________________
PETITIONER’S Address: _____________________________________________________
States that he/she is:
☐ Spouse; ☐ Relative ____________ ☐ Guardian of the above named Respondent
PETITIONER further states that the name, address, and residence of person related to the
Respondent are (if known)
Parents or guardian: _________________________________________________________
Name and complete address
Spouse: ___________________________________________________________________
Name and complete address
Person having custody of Respondent: ___________________________________________
Name and complete address
Nearest Relative: ____________________________________________________________
Name and complete address
Friend: ____________________________________________________________________
Name and complete address
PETITIONER believes that Respondent is a person suffering from alcohol and/or other drug
abuse because: (state facts to support belief)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
FORM 26.0 - PETITION FOR INVOLUNTARY TREATMENT FOR ALCOHOL AND OTHER DRUG ABUSE
Effective Date: July 1, 2016
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