Confidential Intake Form

Date

Do you wish to become a client of Shamac Lawyers?

Matter Type (select all that apply)

If there are upcoming court appearances in your matter, when is the date of the next court appearance and where is it?

Do you have a Centrelink Health Care Card?

We are a private practice, are you expecting Victoria Legal Aid assistance for your matter?

Name

PrefixFirst NameMiddle NameLast Name

Address

Street Address / Postal Address

Street Address Line 2

CityState

Post Code

Postal Address (if different)

Street Address / Postal Address

Street Address Line 2

CityState

Post Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Can we safely call you on this number?

Email

example@example.com

Can we safely email you?

Your Date of Birth

Date

Pronoun

Birth Sex

Country of Birth

Gender Identity

Ethnicity

Do you identify as being Aboriginal, Torres Strait Islander or Aboriginal and Torres Strait Islander?

Are you an Australian citizen or permanent resident, if not, please specify your visa status.

Do you require an interpreter, if so, what language?

Occupation

Employer Name

Employer Address

How did you hear about us?

More than one client?

Other party’s full name (for conflict check)

FirstLast

Other party’s date of birth (if known)

Do you have an emergency contact?

FirstLast

Do you have an emergency contact phone number?

Please enter a valid phone number.Format: (000) 000-0000.

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Is this person aware of your legal matter?

Short description of your legal issue

Have you previously engaged a lawyer for this matter?

Have you attended mediation, negotiation, or Alternative Dispute Resolution?

Are there any current or past court proceedings?

What outcome are you hoping to achieve?

How would you prefer to resolve the matter?

What is your budget to resolve this matter?

Please upload any relevant documents (if available):

1. Court documents, 2. Agreements, contracts, correspondence, 3. Financial documents (bank statements, payslips, tax returns), 4. Property titles, leases, mortgage documents, 5. Wills, powers of attorney, estate documents, 6. Police reports or charge sheets, 7. Medical or psychological reports, 8. Any other relevant material

Do you have any medical issues or personal circumstances we should be aware of?

Do you require adjustments (e.g., disability access, interpreter, support person)?

How do you intend to fund your matter?

What is the best way to contact you?

Is it safe for us to leave a voicemail or SMS?

Are there any urgent deadlines or upcoming dates?

Date

Are you available for meetings or court appearances on short notice?

What medication are you prescribed?

Do you require an in-person consultation? Why?

Do you have any prior convictions?

Are you on bail or summons?

Are you subject to a CCO or Parole Order?

Are you on bail for other matters?

Is there anything else you would like us to know that may assist with your matter?

Do you consent to us contacting relevant professionals (e.g., doctors, accountants, counsellors) if required?

File Upload

Thank you for submitting your information.

Please note that completing this form does not create a lawyer-client relationship. Before we can act for you, we must first assess your matter. Here’s what happens next:

If we are able to assist you and accept your instructions, we will:

1. Conduct a conflict check to ensure we are not currently acting—or have not previously acted—for any other party involved in your matter,
2. Request any proof of your identity or copy of any relevant documents
3. Provide you with a Costs Disclosure and/or Costs Agreement, and
4. Ask for an initial payment to begin work on your matter.

If we are unable or choose not to act on your behalf, we will inform you and promptly delete any personal information you have provided. If you decide not to proceed with our services, your personal information will also be deleted. Until that point, your information is securely stored in accordance with the Privacy Act 1988 (Cth).

Because this form is only used to collect preliminary information, no conflict of interest arises if you make an initial enquiry and later decide not to engage our services, even if we go on to act for the other party.

Please note: We cannot provide legal advice until we formally accept you as a client and a Costs Agreement and Disclosure Statement is accepted. Until that point, any communication is general in nature and should not be considered legal advice. Once a lawyer-client relationship is formed, your communications with us are protected by client legal privilege.

By signing or submitting this form, you acknowledge that you have read and understood the above terms and the contents of this document are true and correct to the best of yourknowledge.

Signature

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Confidential Intake Form

Your Details

B. Safety, Conflicts & Emergency Contact

C. Legal Matter Overview

D. Objectives & Pathway

E. Documents

F. Health & Other Considerations

G. Payment & Funding

H. Communication & Availability

I. Criminal Law / Intervention Order

J. Additional Information

What Happens Next & Important Information