FORM VII
(See Rule 25)
Application for reception order
(By Medical officer in char-e of a psychiatric hospital)
From
Dr …………….
To
*The Magistrate, ……………………
Sir,
Subject: Reception order for.. …………... son/daughter of …………..
            I, Dr ………….. maintain psychiatric hospital\nursing home at ……… under licence No ……….dated ……………
            I request you to issue reception order in respect of Sh./Smt …………… son/daughter of ………… who is being treated at my hospital as a voluntary patient and is not willing to continue. He/she has, the following symptoms and/or signs.
1.
2.
3.
He/She requires to be in the hospital for treatment\personal safety/others protection.
Thanking you,  
Yours Sincerely,
Signature………
Name………
Place ………. 
Date ………….          
*"Magistrate" means, --
(1) In relation to a metropolitan area within the meaning of Cl. (k) of Sec. 2 of the Code of Criminal Procedure, 1973 a Metropolitan Magistrate;
(2) In relation to any other area, the Chief Judicial Magistrate, Sub-Divisional Judicial Magistrate or such other Judicial Magistrate of the first class as the Government may, by notification, empower to perform the functions of a Magistrate under this Act.