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Tuscola Mental Health Court Referral Form
TUSCOLA MENTAL HEALTH COURT
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Today's Date
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MM
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DD
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YYYY
Case Number:
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Your answer
Referrral Source:
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Your answer
Relationship to Client:
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Your answer
Client Name:
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Your answer
Client Phone:
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Your answer
Client Address:
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Your answer
Date of Birth
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MM
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DD
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YYYY
Gender:
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Male
Female
Other:
Is this person a resident of Tuscola County?
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Yes
No
What are the current charges?
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Your answer
On Bond?
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Yes
No
Currently Incarcerated?
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Yes
No
Plea Hearing Date:
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MM
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DD
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YYYY
Sentencing Date:
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MM
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DD
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YYYY
Attorney (name, Phone, Fax):
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Your answer
Please have the client read and sign the consent form.
https://www.tuscolacounty.org/courts/doc/TMHC-Multiple-Party-Consent-2020.pdf
Has the consent form been read and signed by the client?
Yes
No
Clear selection
Provided copy of Complaint and Police Report via fax or email (989) 672-1895,
vbishop@tuscolacounty.org
*
Yes
No
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