California Code, Welfare and Institutions Code - WIC § 5207

The order for evaluation shall be in substantially the following form:

In the Superior Court of the State of California for the County of ․

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The People of the State of California	No. ․․․․․․․․․
Concerning	Order
․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․ and	for
․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․	Evaluation
Respondents	or Detention
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The People of the State of California to :

(Peace officer, counselor in mental health, or other official appointed by the court)

The petition of ․․․․․․․․․․ has been presented this day to me, a Judge of the Superior Court for the County of ․․․․․․․․․․, State of California, from which it appears that there is now in this county, at ․․․․․․․․․․, a person by the name of ․․․․․․․․․․, who is, as a result of mental disorder, a danger to others, or to himself, or gravely disabled.

Now, therefore, you are directed to notify ․․․․․․․․․․ to submit to an evaluation at ․․․․․․․․․․ on the ․․․․․․․․․․ day of ․․․․․․․․․․, 19․․․, at ․․․ o'clock ․․․m.

․․․․․․․․․․ shall be permitted to be accompanied by one or more of his relatives, friends, an attorney, a personal physician, or other professional or religious advisor.

The individual or individuals who accompany ․․․․․․․․․․ may be present during the evaluation if so requested by ․․․․․․․․․․.

* Provision for Detention for Evaluation

If the person fails or refuses to appear for evaluation when notified by order of this court, you are hereby directed to detain said ․․․․․․․․․․ or cause him to be detained at ․․․․․․․․․․ for a period no longer than 72 hours, excluding Saturdays, Sundays, and holidays if evaluation services are not available on those days, for the purposes of evaluation.

I hereby direct that a copy of this order together with a copy of the petition be delivered to said person and his representative, if any, at the time of his notification; and I further authorize the service of this order at any hour of the day or night.

Witness my hand, this ․․․․․․․․․․ day of ․․․․․․․․․․, 19․․․.

^*This paragraph is applicable only if the person to be evaluated fails or refuses to appear for evaluation after having been properly notified.

Return of Order

I hereby certify that I received the above order for the evaluation of ․․․․․․․․․․ and on the ․․․․․․․․․․ day of ․․․․․․․․․․, 19․․․, personally served a copy of the order and of the petition on ․․․․․․․․․․ and the professional person in charge of the ․․․․․․․․․․, a facility for treatment and evaluation, or his designee.

Dated: ․․․․․․․․․․, 19․․․.