Sonoma — Mental Health Diversion Application

Source: https://sonoma.courts.ca.gov/system/files/forms-and-filings/mhd-application-121125_0.pdf

Attorney For (Name): For Court Use Only

Telephone No: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA

Street Address: 600 Administration Drive City and Zip Code: Santa Rosa, CA 95493

Hearing Date: State of California vs. , Defendant
Time:
Dept:
APPLICATION FOR MENTAL HEALTH DIVERSION Case Number:
(Penal Code § 1001.36)

Notice is given that the above defendant (applicant) hereby applies for Mental Health Diversion pursuant to Penal Code section 1001.36. An informal hearing on prime facie eligibility pursuant to Penal Code section 1001.36, subsection (b), will be conducted in the Mental Health Diversion Court on the designated calendar.

1. Applicant alleges applicant suffers from a qualifying mental disorder. Documentation reflecting a recent mental health diagnosis or mental health treatment within the past 5 years by a qualified mental health expert is attached.

2. Applicant alleges a mental health disorder played a significant role in the commission of the alleged offense(s).

3. Applicant consents to submit a signed Universal Release of Information form so that the court may consider statements by a mental health treatment provider, medical records, records, or reports prepared by qualified medical experts, and/or any other relevant information in accordance with Penal Code section 1001.36(b)(2). Consent is not required where Applicant has been found to be mentally incompetent to stand trial.

4. Applicant’s current legal status (circle one): a. Applicant is competent to stand trial. b. Applicant was found incompetent to stand trial.

Dated: Respectfully Submitted,

Attorney for Applicant

Local Form CR-007 APPLICATION FOR MENTAL HEALTH DIVERSION Form Adopted for Optional Use 06/09/2025 , 12/11/2025 Page 1 of 1