Mental Health Litigation Division 2015 Attorney Registration printable pdf download

Mental Health Litigation Division 2015 Attorney Registration

The Commonwealth of Massachusetts

Committee for Public Counsel Services

Mental Health Litigation Division

44 Bromfield St., 2

Fl., Boston, MA 02108

TEL: 617-988-8341

FAX: 617-988-8488

ANTHONY J. BENEDETTI

MARK A. LARSEN

CHIEF COUNSEL

DIRECTOR

MENTAL HEALTH LITIGATION DIVISION 2015 ATTORNEY REGISTRATION

Attorney Name:

Office Address:

Phone:

Fax:

E-mail address:

B.B.O. Number:

Languages Spoken:

Guardianship Panel: (Y/N)__________ If yes, I am available to accept emergency appointments from the Probate

Courts: (Y/N)________. If yes, I only want emergency appointments from the following Probate

Courts:______________________________________________________The best number to reach me for

emergency appointments is________________.

Commitment Panel: (Y/N)_______. If yes, I am also interested in accepting 9(b) Application for Discharge cases

in Superior Court (Y/N)_______. [Mentors are available for 9(b)s.]

Mental Health Appeals: (Y/N)_____. Note - if you are not currently certified for mental health appeals, but have

prior appellate experience and are interested in applying for a waiver, please state “Yes” here:______.

By submitting this form, I certify that I do not represent institutional petitioners in mental health matters.

(Signature not required. Occasional representation of private, non-institutional parties is not precluded.)

Please fill out the attached Court Preference Form and return it, along with this registration form via e-mail to:

mhpanelregistration@publiccounsel.net.

Mental Health Litigation Division 2015 Attorney Registration