Referral

Refer your client

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

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

If you need legal help for yourself, please call 1800 133 302 or fill out our get help form.

Referral Date

Which organisation do you work for?

Your first name

Your last name

Your contact number

Your email

Area of law client needs assistance with

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

Does the client have any legal matters in Court at the moment?

Does the client have a court date?

Which court does the client need to attend?

What type of hearing is it?

If you are not sure, please select Unsure

Client's first name

Client's last name

Client's date of birth

First name of the other person who is involved in the client's legal issue

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

Last name of the other person who is involved in the client's legal issue

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

Date of birth of the other person involved in the client's legal issue

If unknown, enter 01/01/1900

Details of additional other parties (if applicable) and first name, last name and dates of birth for all the client's CHILDREN

If you do not have this information, please enter the number of dependent children the client has. If the client does not have children, please leave this blank

Client's contact number

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

When is the safest time to call the client?

Is it safe for us to leave the client a voicemail?

Is it safe for us to send an email to the client?

Client's email

Does your client identify as an Aboriginal or Torres Strait Islander?

What is your client's country of birth?

What is your client's residency status in Australia?

Does the client need an interpreter?

If an interpreter is required, for which language?

Have you assessed whether your client meets our general eligibility criteria?

Is the client currently employed?

What is the client's average weekly income?

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

Is the client receiving Centrelink payments? If so, what type of payment(s) are they receiving?

If they do not have an income, how are they supporting themselves?

How much money does the client have in their bank account(s)?

Does the client own any properties (either by themselves or with another person)?

What is the value of each property they own?

How much is the mortgage on each property?

Do they currently have a lawyer acting for them?

Is there any information we should about the client's safety? Please include safest and best way to contact the client

Documents you are able to provide if available

If you have these documents, with client consent, please email to [email protected]

If there are other documents you are able to provide, note the type of document here

Is there anything else you would like us to know?

Referral

Refer your client

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