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Florida Baker Act Forms - DrGeorgeZaky.com 2026

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The document is a Certificate of Professional Initiating Involuntary Examination, used by licensed mental health professionals in Florida to certify that an individual meets the criteria for involuntary examination due to mental illness. It includes sections for personal examination details, criteria for involuntary examination, supporting evidence of the individual's mental state, non-compliance with treatment orders, and information for law enforcement. The form must be completed legibly and transported with the individual to the receiving facility.

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Click ‘Get Form’ to open the Florida Baker Act Form in our editor.
Begin by entering your name and the time of examination in the designated fields. Ensure that the time is within the preceding 48 hours.
In Section I, check the appropriate boxes indicating whether the person has refused voluntary examination or if they are unable to determine their need for examination. Provide any relevant mental health diagnoses and DSM codes.
In Section II, document your observations supporting the criteria for involuntary examination, focusing on behaviors related to suicidal ideation or self-injury.
Complete Section III with any additional information from other sources that influenced your conclusion about the person's mental state.
If applicable, fill out Section IV regarding non-compliance with an involuntary outpatient placement order, detailing efforts made to solicit compliance.
Provide identifying information in Section V for law enforcement purposes, including age, gender, race/ethnicity, and any other relevant details.
Finally, sign and date the form in Section VI. Ensure all sections are completed legibly before saving or printing your document.

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