Please review the information below. If everything is correct, click “Send”. To go back and edit your entries, click “Edit”.
The following required items were not provided or are in the wrong format. Please provide the required responses and submit again:
PETITIONER INFORMATION:
Petitioner's Name: (person filling out this form)
Phone:
Email:
Address:
City:
State:
Zip:
SUBJECT OF PETITION:
Subject's Name: (person in need of treatment)
Date of Birth:
Address: (must be in Milwaukee County)
City:
State:
Zip:
Does the subject have a mental illness?
If yes, what illness(es)?
Was the subject prescribed any medications?
Which medication(s)?
Is the subject taking them?
Does the subject have a drug dependency/addiction?
If yes, to what drug(s)?
How often is the subject using?
VIOLENT OR DANGEROUS EVENTS:
To file a Three-Party Petition, all petitioners must have seen the subject within the past 60 days doing things that were dangerous and/or violent. This includes actual violence, threats to harm himself/herself or others, gathering weapons, or careless acts that put himself/herself or others in danger of getting hurt. It does not include behavior that was loud, angry, or delusional, but did not include any violence or threats.
Please list and describe each event of the subject’s dangerous, threatening, or violent behavior that you have personally seen within the past 60 days. Do not list older events or events you heard about from other people. Include as much detail about each event as you can remember.
- If you have seen more than three dangerous or violent events in the past 60 days, just list the three most dangerous events you saw.
- If you are not sure of the date of an event, saying “on or around” a date is fine.
- If the subject is living somewhere outdoors, unsanitary, unheated, abandoned, or unsafe, you may email any photos you have of the subject’s living space to CorporationCounsel3PartyPetitions@milwaukeecountywi.gov.
EVENT 1
Date:
Location:
What Happened:
EVENT 2
Date:
Location:
What Happened:
EVENT 3
Date:
Location:
What Happened:
ATTACHMENTS:
If you have any photos or additional event descriptions to give us, please email them to CorporationCounsel3PartyPetitions@milwaukeecountywi.gov.
Thank you for contacting the Office of Corporation Counsel. Once our office has reviewed your screening form, we will contact you with more information.
Please note that our office responds to all requests in the order they are received, and we cannot guarantee an immediate response.
If this is an emergency, if the person becomes violent, or if the person threatens to hurt himself/herself or others at any time, call 911.
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