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Home
About Us
Menu Toggle
Governance and Membership
Work or Volunteer
Donate
Legal Services
Menu Toggle
Outreaches
Aboriginal Services
Family Law
Family Law – Referral Form
Community Legal Education
Legal Health Check
Tenant Services
Menu Toggle
Intake Form
Outreaches
Domestic & Family Violence
Disaster Response
Resources and Fact Sheets
Contact Us
Become a member
Northern Rivers Community Legal Centre
Family Law - Referral Form
Step
1
of
5
20%
Referral form for family law advice
1. Service name
(Required)
2. Name of referrer
(Required)
3. Date of referral
(Required)
Month
Day
Year
4. Contact details
(Required)
5. The client has provided authority for referrer to refer this client and to provide the following details to NRCLC. The client has authorised NRCLC to contact them to discuss an appointment
(Required)
Yes
No
Client details
6. Client name (including any previous names)*
(Required)
7. Date of birth
(Required)
Month
Day
Year
8. Address
(Required)
9. Phone
(Required)
10. Safe to call?
(Required)
Yes
No
11. Safe to leave a message?
(Required)
Yes
No
12. Email
(Required)
13. Any additional notes on preferred contact method
14. What country was the client born in?*
(Required)
15. Does the client identify as Aboriginal or Torres Strait Islander?
(Required)
Aboriginal
Torres Strait Islander
Both
No
Rather not say
16. What main language does the client speak at home?
(Required)
17. Does the client require an interpreter?
(Required)
Yes
No
Language?
Other party details
18. Other party name (including any previous names)
(Required)
19. Date of birth
(Required)
Month
Day
Year
20. Name(s) and date of birth of any other party/ies (e.g. grandparent):*
(Required)
Domestic Violence/Family Violence
21. Alleged violence perpetrated by:
(Required)
Client
Other Party
22. Are children exposed to DV/FV:
(Required)
Yes
No
23. Child(ren):
Full name
Gender
Date of birth
Age
Living with?
Add
Remove
Client vulnerabilities:
24. Is the client
Homeless/vulnerably housed
Drug/alcohol/substance abuse
One of the parties in prison
Under 18 years old
Extreme DV/FV
Entrenched conflict
Mental health issues
Disability
Other
25. Employment Status:
(Required)
Paid Employment
Benefit
None
Other
Income per week
26. Legal Issues Identified:
(Required)
Assistance with ADVO (getting/understanding/complying)
Court documents (understanding/complying)
Parental responsibilities (understanding/complying)
Draft parenting plan/consent orders
Legally assisted FDR
Other
Legal Proceedings/Court Orders/Parenting Plan
27. ADVO
(Required)
Current
Previous
Attached
N/A
28. Parenting Plan
(Required)
Current
Previous
Attached
N/A
29. Family Law Orders
(Required)
Current
Previous
Attached
N/A
30. Children’s Court (care and protection) orders
(Required)
Current
Previous
Attached
N/A
31. Please upload documents relevant to the referral:
Drop files here or
Select files
Max. file size: 30 MB.
