Illinois Application for Voluntary Admission

To submit this form, you can print it out and personally deliver it to the designated mental health facility. Alternatively, you may choose to send it via fax to the facility's admissions office. Ensure to check the facility's website for their specific submission email and online forms for a more efficient process. It’s advisable to keep a copy for your records after submission.

Key submission dates for this form are typically set according to the admission policies of the facility. Ensure to check specific deadlines each year in 2024 and 2025 to comply with facility regulations. Staying informed will help facilitate a smooth admission process.

The purpose of this form is to formally request the voluntary admission of an individual to a designated mental health facility in Illinois. It ensures that individuals understand their rights and the conditions associated with their admission. This form also facilitates communication with relevant parties to keep them informed about the individual's status.

• 1. Facility: Name of the facility where the application is being submitted.
• 2. Name of Admittee: Full legal name of the individual being admitted.
• 3. Address: Complete address including street, city, county, state, and zip.
• 4. Date of Birth: Admittee's date of birth.
• 5. Date of Application: Date on which this application is filled out and submitted.
• 6. Signature of Admittee: Signature to affirm consent to the admission process.
• 7. Witness Signature: Name and signature of a witness present during the signing.
• 8. Certifications of Suitability: Fields for certifying the admittee's clinical suitability for voluntary admission.

Failing to submit this form may delay the admission process, potentially affecting the individual’s access to necessary mental health services. Without the completed application, the facility cannot adequately inform other parties involved or make arrangements for the individual’s care.

• Delayed Treatment: The individual may experience delays in necessary mental health interventions.
• Inability to Notify: Other relevant parties may not be informed of the individual's admission.
• Legal Non-Compliance: Failure to comply with admission requirements can lead to legal complications.

• 1. Voluntary Admission Requests: Use this form to request the voluntary admission of an individual to a mental health facility.
• 2. Guardian Admittance: When a guardian needs to admit a minor, this form documents consent.
• 3. Emergency Situations: In urgent cases, this form allows for expedited processing of admission.