Any person desiring and needing psychiatric treatment in a state facility for the mentally ill as a voluntary consumer may present a written application to the judge of the district court:

1. 1. Of the county in which the person resides; or

2. 2. Of the county in which a state hospital for the mentally ill is located. The application may be in substantially the following form:

   IN THE DISTRICT COURT OF _________________________ COUNTY, OKLAHOMA
   In the Matter of the Mental Health of No._________
   on the Mental Health Consumer Docket

   APPLICATION FOR VOLUNTARY ADMISSION TO MENTAL FACILITY

   I declare that my name is ____, that I am ____ years of age, and that I reside in ____ County, Oklahoma, my permanent residence address being as follows:

   _____________________________________________________________________________

   I have obtained medical advice concerning my condition, and I desire to be admitted to the ____ State Facility at ____, Oklahoma, as a voluntary consumer under the provisions of the Mental Hospital Voluntary Admission Procedures Act. I understand that if admitted to this facility I may be detained in this facility until the executive director of this facility concludes that it is proper for me to be released, not exceeding, however, a period of seventy-two (72) hours after I give written notification to the executive director or a designee of my desire to leave the facility.

   I declare that the names and addresses of my close relatives are as follows:

   Father: _______________________

   Mother: _______________________

   Spouse: _______________________

   Adult Children: _______________

   Other: ________________________

   Dated this ____ day of _____, 20__.

   ______________________________
   (Signature)

Added by Laws 1963, SB 210, c. 81, § 2, emerg. eff. May 21, 1963; Renumbered from 43A O.S. § 552 by Laws 1986, HB 2021, c. 103, § 103, eff. November 1, 1986; Amended by Laws 1986, HB 2021, c. 103, § 71, eff. November 1, 1986; Amended by Laws 2002, SB 1624, c. 488, § 36, eff. November 1, 2002 (superseded document available); Amended by Laws 2005, HB 1845, c. 150, § 42, emerg. eff. May 9, 2005 (superseded document available).