Referral

We ask you to fill out this form so we can work out if we can support you with your legal problem and if you are eligible for our services.

The information you provide here will be confidentially and safely saved in our system. Our administrative staff, paralegals and lawyers will use this information to contact you, make an appointment with a lawyer and work out how we can assist you.

We aim to get in touch with you within 5 business days of you submitting this form.

Enquiry Date

What kind of legal issue do you have?

Please hold the 'Ctrl' button if you need to select more than one area that you need legal help with

Do you have to go to court?

When is your next Court date?

Which court would you need to attend?

What type of hearing is it?

If you are not sure, please select Unsure

Are you experiencing family violence?

Family violence happens when one person in a relationship hurts another or makes them feel unsafe, and is a repeated pattern of behaviour

Your first name

Your last name

Your preferred name

Your date of birth

First name of the other person who is involved in your legal issue

This could include the person using violence, including ex-partners

Last name of the person involved in your legal issue

This could include the person using violence, including ex-partners

Date of birth of the other person involved in your legal issue

If unknown, enter 01/01/1900

First Name, Last Name and Date of Birth of any other person involved in your legal issue (if applicable)

If you do not have any additional people involved, please leave this blank

First Name, Last Name and Date of Birth for all of your children

If you do not have any children, please leave this blank

Are you experiencing homelessness?

Are you staying in a refuge, emergency accommodation, couch surfing or sleeping rough

What is the postcode for where you live or stay?

Your contact number

Your email

If you don not have one, please enter n/a

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

When is the safest time to call you? If it is not safe to call you, please tell us and we will contact you by email.

Is it safe for us to leave you a voicemail?

Is it safe for us to send you an email?

What is your gender?

Do you identify as an Aboriginal or Torres Strait Islander person?

What is your country of birth?

What is your residency status in Australia?

What is the main language you speak at home?

Do you require an interpreter?

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

If "Other" is selected above, would you like to provide further details?

Are you currently employed?

Are you receiving Centrelink payments? If so, what type of payment(s) are you receiving?

What is your average weekly income?

This include income from Centrelink (but does not include Family Tax Benefit), your employer or any other financial support you receive

If you do not have income, how are you supporting yourself?

How much money do you have in the bank?

Do you own any property (either by yourself or with another person)?

What is the value of each property you own?

How much is the mortgage on each property?

Do you have a support worker?

If you have a support worker, what is their name and which organisation are they from?

Can we contact your support worker?

What do you need help with?

Referral

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