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Baker Act Forms
The links on this page all require the use of the Adobe Reader which is free from the Adobe.com web site or Microsoft Word which can be viewed using Office Online if needed.
IMPORTANT: Mandatory Forms may NOT be altered.
Recommended forms are those which are not required by the department, but which have been determined to satisfy the specific requirements for which the form was developed. Alterations of recommended forms may jeopardize this status.
Baker Act Forms - Mandatory
(IMPORTANT: Mandatory Forms may NOT be altered.)
- CF - MH 3052a Jul. 2020: Report of Law Enforcement Officer Initiating Involuntary Examination
- CF - MH 3052b Jul. 2020: Certificate of Professional Initiating Involuntary Examination
- CF - MH 3084 Feb. 2005: Baker Act Service Eligibility
- CF - MH 3089 Feb. 2005: Transfer Evaluation (To a State Mental Health Treatment Facility)
- CF - MH 3100 Feb. 2005: Transportation to Receiving Facility
- CF - MH 3118 July 2020: Cover Sheet to Department of Children and Families
- CF - MH 3125 Feb. 2005: Application for Designation as a Receiving Facility