Refer a Client – Southside Justice

Community Partner Referrals

Workers from organisations participating in our Partners in Place program are encouraged to complete the referral form. When received, we will reach out directly to the client to arrange next steps.

Please ensure you have the consent of your client before completing. To learn more about the information we collect, please see our Privacy Policy.

Community Partner Referrals

"*" indicates required fields

Which community organisation are you from?*

Client Full Name*

Client's Date of Birth*

Client's Pronouns

Client's Phone Number*

Client's Email

Is it safe to contact the client?*

Yes

Unsure

Preferred client contact method*

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

Yes

Unsure

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

Brief Outline of Legal Matter*

Is an interpreter required?*

Yes

Unsure

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 Email

Please upload any relevant documents or signed general authority if applicable

File

Drop files here or

Max. file size: 128 MB, Max. files: 5.