web analytics

Physicians Statement Of Mental Competency

Free Printable Physicians Statement Of Mental Competency FormFree Printable Physicians Statement Of Mental Competency Form

Physicians Statement of Mental Competency

Mental Competence is an important key to rational decision making which unfortunately may be affected by diseases or injury or substance making it rather difficult for an individual to make proper and rational decisions. It also incapacitates ones ability to handle his or her own affairs. Mental competence affects important tasks such as the making of wills, getting married, entering into contracts, medical treatments, driving of a vehicle, or giving the power of attorney. It is also a concern because it may cause an individual to lose many things including their lives from incorrect decisions such as an accident in driving. Legally, laws “assume that every adult is mentally competent until a court decides otherwise.” In a legal sense, the degree of mental competence required will vary according to the nature and legal impact of the steps that they wish to take. There exists a degree of mental competence because mental competence is not something that one may or may not have, it is something that develops early and deteriorates later in life.

If someone is deemed mentally incompetent, an example being that he or she is not able to care for his or her own affairs, a Mental competency assessment is needed. When a person is considered mentally incompetent, he or she may be able to give someone, such as a family member, his or her power of attorney granting the assigned individual power over their relatives legal and financial matters. A physicians statement of mental competency is a legal form, which includes the name of the physician and the office work place address, that states wether or not an individual is mentally competent. It is made and signed by the said licensed and professional physician.

Physician’s Statement of Mental Competency

I, __________________(“Physician”), with offices at __________________________, hereby state that _____________________ (“Individual”) of ______________________, is fully and completely mentally competent in the broadest meaning of that term, and fully capable of taking independent actions as a completely mentally competent person.


___________________ Date:

Physician’s Statement of Mental Competency
Review List

This review list is provided to inform you about the document in question and assist you in its preparation. This document should accompany any Power of Attorney, if possible. It helps short circuit any challenges to the Power of Attorney.

1. Make multiple copies and have them attached to the Power of Attorney statement, in your distribution of it and storing of them.

Download DOC Download DOCX Download RTF Download PDF


  1. Ava Brown
  2. Madison Moore
  3. Emma Smith
  4. Sophia Johnson
  5. Emily Miller
  6. Olivia Williams
  7. Elizabet Taylor
  8. Isabella Jones
  9. Abigail Wilson

Leave a Reply