The form is filled out by a petitioner, who can be a department, a county department, an agency, or another interested person. The petitioner must state their relationship to the person needing care.

What does the petitioner ask the court for?

The petitioner asks the court to order a hearing, appoint a guardian ad litem, make a referral for an attorney, and make findings that the person meets the standard for involuntary medication.

Are there required attachments?

Yes, the form requires a written statement signed by a physician who has personal knowledge of the person to provide clinical information about the medication.

GN-4170

Petition for Involuntary Administration of Psychotropic Medication (with Petition for Protective Services)

Wisconsin · Wisconsin Court System · Effective May 30, 2024

This form is used to ask the court to allow for the involuntary giving of medication that affects mental state. It asks the court to make findings that the person needs protective services and that the medication is necessary.

The court describes it as: To petition for involuntary administration of psychotropic medication.

Open the official PDFfrom Wisconsin Court System

Where this fits in a case

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Stage: Start a case

This form is used when someone needs to ask the court to order medication for a person who cannot agree to take it themselves. It involves filing a Petition for Protective Services as well.

Either party may file.

Official instructions

How-to guides published by the court for this form.

Plain-language summary

Common questions

Who files this form?: The form is filled out by a petitioner, who can be a department, a county department, an agency, or another interested person. The petitioner must state their relationship to the person needing care.
What does the petitioner ask the court for?: The petitioner asks the court to order a hearing, appoint a guardian ad litem, make a referral for an attorney, and make findings that the person meets the standard for involuntary medication.
Are there required attachments?: Yes, the form requires a written statement signed by a physician who has personal knowledge of the person to provide clinical information about the medication.<0xC2><0xA0>

Revision history

No changes recorded since we started tracking this form on October 10, 2026. The current version took effect May 30, 2024.

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