Confidential Capacity Assessment and Declaration—Probate Conservatorship
California · Judicial Council of California · Effective January 1, 2025
This form is a confidential document used by a doctor, psychologist, or religious healer to assess a person's mental ability. It asks the clinician to describe the person's mental functioning and provide their professional conclusions under oath to the court.
The court describes it as: This form is to be completed by a Physician, Psychologist or Religious Healing Practitioner to tell the court about the mental capacity of a potential conservatee.
Where this fits in a case
HearingStage: Hearing
This form is used in a probate conservatorship case when a professional needs to assess the mental capacity of a person who might need a conservator. The petitioner fills out instructions for the clinician, who then completes the assessment.
Either party may file.
Official instructions
How-to guides published by the court for this form.
Common questions
- Who fills out this form?
- The petitioner fills out the initial instructions, but the clinician (a physician, psychologist, or religious healing practitioner) completes the main assessment parts. The form is for court use only and must be kept confidential.
- What does this form assess?
- It assesses the person's general physical and mental health, as well as their mental functioning in areas like memory, attention, and reasoning ability.
- Is this form filed with the court?
- The form states that the petitioner should not send a copy of the petition to the court, and the clinician should secure or destroy their copy.
Revision history
No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2025.
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