Client Form
Name
*
First Name
Last Name
Phone Number
*
Please enter your phone number if it is safe to call
Address
*
Street Address
Street Address Line 2
City
State
Postcode
State
*
Please Select
NSW
VIC
WA
NT
QLD
TAS
SA
Postcode
*
Email
*
example@example.com
Do you live in or have a legal matter in one of the following LGA's:
*
Albury
Wodonga
Greater Hume
Wangaratta
Murray
Benalla
Edward River
Mansfield
Federation Council
Alpine
Murrumbidgee
Towong
Berrigan
Indigo
Snowy Valleys Council
Wagga Wagga
Lockhart
Other
Unfortunately, our service is unable to help you with your matter as you live outside of our catchment area. If you live in NSW, please call Law Access 1300888529 and if you live in VIC, please contact Victoria Legal Aid 1300792387.
Unfortunately, our service is unable to help you with your matter as you live outside of our catchment area. If you live in NSW 1300888529, please call Law Access and if you live in VIC, please contact Victoria Legal Aid 1300792387.
How did you hear about our service?
*
Women's Centre
WDVCAS
Yes Unlimited
Intereach
Vinnies
Foodshare
Murrumbidgee Health
Police
Amaranth Foundation
Courts
AWAHS
Gateway Health
Centre Against Violence
NESAY
Flexible Learning Centre
UMFC
Headspace
Legal Aid
Other
Unfortunately, we are unable to help you with your matter as we can only accept clients referred by above organisations. If you live in NSW, please call Law Access 1300888529 and if you live in VIC, please contact Victoria Legal Aid 1300792387.
Legal Issue you are facing
*
Money Problems
Centrelink
Housing Problems
Family or relationship
Wills
Criminal
Employment
Others
Money Problems
*
Do you have a credit card loan or other debts you can't pay? (Including BNOL, payday loans, car loan)
Do you owe money to anyone?
Does someone else control your finance?
Do you have a consumer lease? (e.g. Radio Rentals/Rent4Keeps etc)
Are you being chased for money/received any letters of demand?
Do you have unpaid/overdue accounts - phone, gas electricity, child support, council rates?
Do you have unpaid fines - traffic, parking, court etc.?
Are you out-of-pocket because of dodgy product or service?
My problem is not listed.
Money Problems Backend
Credit and debt owed by client
Consumer credit
Govt/admin issues relating to fines
Consumer complaints products or Consumer complaints services or Consumer complaints financial/insurance/superannuation
Money Problem Numeric
Centrelink
*
Are you having a problem with Centrelink payments?
Do you owe Centrelink money?
My problem is not listed.
Centrelink Backend
Govt pensions/benefits allowances-refusal eligibility or Govt pensions/benefits allowances-review of benefit or Govt pensions/benefits allowances Other
Govt pensions/benefits allowances-recovery overpaymnt
Centrelink Numeric
Housing Problems
*
Are you having trouble paying rent?
Have you recently been given an eviction notice?
Do you have problems with government or community housing?
Do you have repairs, your landlord is not fixing?
Have you moved out from a place and your name is still on the lease?
My problem is not listed.
Housing Problems Backend
Tenancy rent
Tenancy termination by lessor
Tenancy repairs
Tenancy other
Housing Problems Numeric
Family or Relationship
*
Do you have any issues with a written parenting agreement/court order?
Do you feel scared in your relationship or in your home?
Do you worry about your children's safety in your home?
Do you have any problems with Family Violence Orders?
Do you need help with a divorce?
Do you have property or superannuation that needs to be sorted?
Do you have questions or concerns about Child Support or your Child Support Assessment?
Have you had trouble registering your child's birth?
My problem is not listed.
Family or Relationship Backend
Child contacts or contact orders
Family or domestic violence order
Family or domestic violence order or Child protection other
Divorce
Property in marriage or Property de facto
Child support other
Registration
Family or Relationship Numeric
Others
*
Do you think you have been treated unfairly by an organisation/government department?
Do you have a complaint about your phone/energy company?
Do you/your children need birth certificates/ID?
Have you been the victim of a scam?
Have you been a victim of crime?
Have you been in a car accident recently?
Do you have any problems with your insurance (car/house/contents/funeral)?
Do you have any problems with the NDIS?
Have you received a traffic fine over the border and don't know how to deal with it?
Do you have problems arising out of disaster (bushfire/flood etc)?
My problem is not listed.
Others Backend
Consumer complaints products and/or Consumer complaints services
Change name or birth records
Consumer complaints services
Victim compensation
Motor vehicle accident
Consumer complaints financial/insurance/superannuation
Govt/admin issues relating to fines
Others Numeric
Wills
Unfortunately, the area of law you have selected, our service is unable to assist you. If you live in NSW, please call Law Access 1300888529 and if you live in VIC, please contact Victoria Legal Aid 1300792387.
Criminal
Unfortunately, the area of law you have selected, our service is unable to assist you. If you live in NSW, please call Law Access 1300888529 and if you live in VIC, please contact Victoria Legal Aid 1300792387.
Employment
Unfortunately, the area of law you have selected, our service is unable to assist you. If you live in NSW, please call Law Access 1300888529 and if you live in VIC, please contact Victoria Legal Aid 1300792387.
My problem is not listed
Unfortunately, the area of law you have selected, our service is unable to assist you. If you live in NSW, please call Law Access 1300888529 and if you live in VIC, please contact Victoria Legal Aid 1300792387.
Is it safe to contact you? (Select all that apply)
Yes, you can contact me.
Do not call/leave voicemail.
Do not send me a text message.
Do not email me.
Do not mail me.
Safe to contact (Backend)?
Not Applicable
Do not call/leave voicemail
Do not SMS
Do not email
Do not mail
Safe to contact Numeric
Dispute with:
*
An individual
A company
Other Party's Name
*
First Name
Last Name
Other Party's Date of Birth (If known)
-
Day
-
Month
Year
Date
If other party's DOB is unknown, do you know their approximate age?
Company Name
*
Brief Overview of Matter
*
Submit Disappear
Submit
Should be Empty: