Referrals from Community Organisations

Which community organisation are you from? *

Client Full Name *

Client's Date of Birth *

Client Pronouns

Client's Phone Number *

Client's E-mail

Is it safe to contact the client? *

Preferred client contact method *

Is it safe to text or e-mail. the client, or to leave them voicemails? *

Other party's full name (if unknown please indicate) *

Other party's date of birth (if unknown please indicate) *

Other party's relationship to client

Areas of Law *

Brief Outline of Legal Matter *

Is an interpreter required? *

If an interpreter is needed, which language?

Other important information (e.g. mobility issues)

If staff referral, please complete the fields below:

Staff Name

Staff Phone

Staff E-mail

Please upload any relevant documents or signed general authority if applicable

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.