Legal Appointments CLASS form (INTERNAL ONLY)

Date

"Before we start, I need to let you know that any personal information you provide to us including and similar to your name, address, telephone number and e-mail address will not be released, sold, or rented to any entities or individuals outside of Women’s Legal Service Victoria. Women’s Legal Service Victoria will only use the personal information provided by you for the purposes for which it was collected, and any other authorised use. The information Women’s Legal Service Victoria collects may also be used for its own planning and research purposes to improve its services. Are you happy to continue?"

Duty/Roster Lawyer first name

Duty/Roster Lawyer last name

Referrer's Organisation

Referrer's first name

Referrer's last name

Referrer's organisation phone number

Referrer's direct phone number

Referrer's email address

Has the client been assisted by WLSV before?

Client first name

Client last name

Client date of birth

Client other names or DOB used

Please ask for all previous names for a complete conflict check. The client may have changed names due to marriage, choice or have a dead name. If no other names used, please write NA

Client gender Identity

Client gender self-described

Please write NA if already described above

Client pronouns

Client street address

If the client is homeless, please write 'Homeless' here

Client suburb

Client state

Client postcode

Client phone number

Client email address

Is it safe for us to call you on the phone number you have given us?

When is a safe time to call you? If it is not safe to call you, please tell us and we will be in touch by email to make alternative arrangements

Is it safe for us to leave you a voicemail?

Is it safe for us to send you an SMS?

Is it safe for us to send an email to you?

Main language spoken

If the client's main language spoken is not listed above, please specify the language here

If this field is not applicable, please write NA

Do you require an interpreter?

Interpreter used?

Job/Reference number for interpreting service and interpreter name and language

Other party #1 first name

Other party #1 last name

Other party #1 date of birth

If the date of birth is unknown or a guesstimate, please write 1/1/[year]and make a file note to reflect your instructions.

Client's relationship status with other party

What is the first name of your current partner?

If your current partner is the other party, or if you do not have a current partner, please write 'not applicable'.

What is the last name of your current partner?

If you do not have a current partner, please write 'not applicable'.

What is the date of birth of your current partner?

Names and dates of birth of any other parties

If there are no other other parties please write NA. These details will need to be added individually to Actionstep as contacts

Child #1 first name

Child #1 last name

Child #1 date of birth

Names and dates of birth of any other children

If there are no other children please write NA. These details will need to be added individually to Actionstep as contacts

Conflict check complete?

Please conflict check current partner if not the other party and then complete this box. If no partner or partner is the other party, the referral has been accepted and intake has been completed by admin/paralegals so you can assume they have been conflict checked.

No conflict identified

If there are no conflicts, please select this box and continue. This is for record purposes. If conflict identified please stop and speak to a managing lawyer

Cultural Identity

Do you consider yourself to have a disability, impairment or long term condition?

Country of birth

What year did you arrive in Australia?

Country of citizenship

Residency status

What was the most recent date that you arrived in Australia?

Which Visa Type/ Subclass Number did you arrive in Australia on?

What is your current Visa Type/ Subclass Number?

What date does your Visa expire?

Do you need any help with your Visa?

Are you working?

Are you receiving Centrelink? If yes, what type of payment are you receiving?

Where does your income come from?

Income per week after tax

Date cohabitation commenced

Date relationship commenced

Date of marriage

Date of separation

Date of Divorce order

Date divorce order becomes final

Was the client advised of any limitation dates

If the client has not been advised of any limitation dates, or some and not others, please explain why

If you have advised the client of limitation dates, please write NA

Date the client was advised of the limitation

What is the primary relevant limitation date?

Please select this box where there is not yet a specific trigger date but you are still giving the advice

What is the limitation?

Please make any further notes about limitation dates here, including any further applicable limitations and their relevant dates

If you have nothing further to add, please write NA

Has the client had FVIVOs in the past? If so, provide details

If there have been no previous IVOs, please write NA

Is there a current Family Violence Intervention Order?

Date of the most recent IVO/FVSN

Is the IVO an Interim Order or Final Order?

When does the current IVO expire?

Are there current or previous Family Law Act Orders?

What is the date that the most recent Family Law Act Orders were made?

Is there a current or previous parenting plan?

What is the date of the most recent parenting plan?

Are there any previous or current Children's Court Orders in relation to one or more of these children?

Date of the most recent Children's Court Order

What was the most recent Order made in the Children's Court?

What date does/did the Children's Court order expire?

Family violence indicator

Homelessness status

Financial Disadvantage Indicator

At Women's Legal Service Victoria we like to give client's the opportunity to provide feedback about how we have helped them. Is the client ok with someone from Women's Legal Service Victoria contacting them to complete a short survey about how we have helped them? If the client changes their mind later on, the client does not have to complete the survey.

We will be keeping any notes and information related to this appointment for 7 years. After this we will destroy it. Does the client agree to us destroying our records in 7 years time?

WLSV Funding category

Service Type

Family Violence Legal Issues

Family Law Legal Issues

Child Protection Legal Issues

Victims Legal Service Legal Issues

Migration Legal Issues

If there are no known migration issues, please write NA

Outreach location

Mode of service delivery

Family Violence Notes

Family Law Notes

Child Protection Notes

Victims of Crime (VLS) Notes

Migration Notes