Statutory Declaration for Mental Health Treatment - Utah 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your name at the top of the form. Ensure that you are an adult of sound mind, as this declaration is a legal document.
3. In the section regarding symptoms of a diagnosed mental disorder, clearly outline any conditions that may impair your ability to consent to treatment.
4. For psychoactive medications, indicate your consent or refusal by checking the appropriate boxes and specifying any medications and dosages as needed.
5. Next, address convulsive treatment preferences. Again, check the relevant boxes and provide details about the type and number of treatments you consent to or refuse.
6. Fill out your wishes regarding admission to a mental health facility, including specific facilities and duration of stay if applicable.
7. Designate an attorney-in-fact by providing their name, address, and telephone number. This person will make decisions on your behalf if you become incapable.
8. Finally, ensure that two witnesses sign the document affirming they know you and that you signed voluntarily. Their signatures are crucial for the validity of this declaration.

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