Petition For Electro Shock Treatment - Circuit Court Of St. Louis County, Missouri
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1
2IN THE CIRCUIT COURT OF ST. LOUIS COUNTY, MISSOURI
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IN THE CIRCUIT COURT OF ST. LOUIS CITY, MISSOURI
No. ________________
In the matter of
, respondent, a person alleged to be mentally
disordered.
PETITION FOR ELECTRO SHOCK TREATMENT
The petitioner herein states to the court as follows:
1.
That the Petition is a designee of ____________________.
That the respondent,
Age
.
2.
who resides at
St. Louis City, Missouri was admitted to
_________________________________________________
on the _____________ day of
_____________________________ 20_________ as voluntary/involuntary patient.
3.
That the facts which justify the need for Electro Shock Treatment are as follows:
___
treatments over
___
Months
WHEREFORE, petition requests the court to cause a hearing to be had on said application, and at the
conclusion thereof to find that the respondent has a need for Electro Shock Treatment.
Dated this
__
day of
20____.
Appointed Attorney:
Petitioner:
Title:
Address:
Telephone:
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