Family Law Assessment Form

1
A booking will only be accepted if the following is provided:

• Copy of the relevant Orders and/or joint letter confirming agreement of the parties to attend the assessment

• Complete contact details for the parties’ and their legal representatives (please do not leave this information blank)

• Confirmation in writing that funds are readily available to pay the Expert's fee for the assessment and report
2
Name of matter and court reference* This field is required.
3
Are you seeking* This field is required.
Single Expert Report
Child Impact Report / Short Form Report
Mental Health Assessment of Parent only
4
Have there been / are there allegations of violence, threats, or firearm offences? Including domestic violence and / or coercive controlling violence?* This field is required.
YESNO
5
Have there been / are there allegations of drug and alcohol abuse?* This field is required.
YESNO
6
Have there been previous complaint proceedings against professionals involved in the case to date? E.g., child protection services, lawyers, health professionals etc.* This field is required.
YESNO
7
Have there been / are there allegations of child sexual abuse?* This field is required.
YESNO
8
How many children are to be interviewed and what are their ages* This field is required.
Huge
Large
Normal
Small
Ok
Ok
9
Are there any additional people to be assessed including extended family members* This field is required.
YESNO
10
If yes, please provide their name and what their relationship to the child/children is (Please note that it is at the discretion of the Single Expert whether these people will be interviewed)* This field is required.
Huge
Large
Normal
Small
Ok
Ok
11
Which household does the child/children currently live in* This field is required.
Father
Mother
Both
12
Are their funds in trust/readily available to pay for this report? * This field is required.
YESNO
13
Number of pages included in reading material* This field is required.
Less than 500 pages
More than 500 pages
More than 1000 pages
14
Are there any further details you wish to include?* This field is required.
15
Full Name* This field is required.
16
Date of Birth * This field is required.
Date
Year
Month
Day
17
Mobile Number* This field is required.
Please enter a valid phone number.
18
Email Address* This field is required.
example@example.com
19
Full Name* This field is required.
20
Firm Name * This field is required.
21
Contact Number * This field is required.
Please enter a valid phone number.
22
Email Address* This field is required.
example@example.com
23
Full Name* This field is required.
24
Date of Birth* This field is required.
Date
Year
Month
Day
25
Mobile Number* This field is required.
Please enter a valid phone number.
26
Email Address* This field is required.
example@example.com
27
Full Name* This field is required.
28
Firm Name* This field is required.
29
Contact Number* This field is required.
Please enter a valid phone number.
30
Email Address* This field is required.
example@example.com
31
Full Name* This field is required.
32
Firm Name* This field is required.
33
Contact Number* This field is required.
Please enter a valid phone number.
34
Email Address* This field is required.
example@example.com
Should be Empty: