Request leave for restricted patients

Complete this form to apply for S17 leave for a restricted patient being treated for mental health issues at your hospital.



This form should be filled in by the clinician responsible for the restricted patient’s care.

Complete the relevant form depending on which type of S17 leave of absence you are requesting for the patient. You can also use it to report changes in the patient’s circumstances.

The Secretary of State must have an up-to-date report on all previous leave before considering any new requests.

Check the attached guidance if you need more information.

Email the completed document to:

After the patient has returned, you must fill in a completed leave report.

Published 27 February 2011
Last updated 18 December 2020 + show all updates
  1. Updated 'Guidance for medical professionals dealing with leave for restricted patients'

  2. Updated leave application form attachment

  3. updated email address for completed submissions

  4. Updated leave application and medical leave application forms.

  5. Updated instructions for sending completed forms

  6. Leave application form for restricted patients updated

  7. Addition: Medical leave application form for restricted patients

  8. Updated form and guidance

  9. First published.