Client Intake

First name(s)

Last name

Is it safe to (select all that apply):

Call (from a private number)

Leave a voicemail

Text message

Phone number

Email address

Preferred method of contact (select all that apply):

Phone call/voicemail

Text message

Email

Street address

City/Town

Postcode

Is it safe to post you mail?

Country of birth

Do you identify as Aboriginal and/or Torres Strait Islander?

What is your first language (if not English, would you like us to book an interpreter?)

Are you living with a disability or mental illness?

Do you receive a Centrelink payment?

Marital status

Full name and date of birth of all children (under 18)

Please only answer the below questions if you are comfortable to do so.

Are you currently experiencing (or at risk of) family violence or other abusive behaviours, or have you experienced these in the past?

If you would like to provide more information about the types of behaviours you have been experiencing, please let us know below:

Are there any current concerns for your safety, or for your children?

Are you confident to reach out for help if you felt that you needed to? e.g. police, family or friends.

Please proceed to the next page to provide information about your legal problem.

Client intake form