Generalist Form

Personal Details

Family Name*

First and Middle Names*

Any other names used (maiden name?)

Address*

Postal Address (if different)

Email*

Name of any adult attending appointment with you

If another person accompanies you in your appointment you may be waiving client legal privilege.

Home Phone

Work / Mobile Phone

Date of Birth*

Client Type*

Individual
Couple
Organisation / Group

Gender*

Male
Female

Can we contact you?*

at home
at work (during day)
on mobile
via email

May we leave a message?*

Yes
No

Statistical Details

Do you identify as

Aboriginal
Torres Strait Islander
South Sea Islander
N/A

Country of Birth

Year of Arrival

Main Language

Request Interpreter?

Yes
No

Spoken*

Very well
Well
Not well
Not at all

Written*

Very well
Well
Not well
Not at all

Employment Status*

Employed
Unemployed
Retired

Centrelink Payment*

Yes
No

Centrelink Payment type

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Income scale / Money received (per week) (eg wages / pension / superannuation)*

Family Type*

2 parent with dependent children
Single parent with dependent children
Living independently

Do you have a disability?*

Yes
No

Disability Type

Legal Matter / Type

1.

2.

3.

4.

Other Parties

Name

Relationship to you

Date of Birth

Phone

Address

Their solicitor

Contact with MRCLC

Have you had contact with MRCLC before?

Yes
No

Date of Last Contact

How did you hear about us?

Is Family Violence an issue in this matter?

Yes
No
N/A

Disclaimer

IF MARRIED: You can apply for property orders from the family law courts at any time up to 12 months from the date your divorce becomes final.

IF A DE FACTO: You may be able to apply for property orders from the family law courts up until 2 years from the date of separation.

It is extremely important that you have a legally binding agreement or have commenced legal proceedings in the family law courts before this time limit expires if you intend to seek a property settlement. If you are outside the time limit you should obtain legal advice immediately in relation to your position as you may be able to seek leave (ie permission) from the court to extend this timeframe.

In almost all cases each person pays their own legal costs in family law proceedings. No taxation or financial advice is able to be given by the MRCLC.

I confirm I have read and agree to the above disclaimer.*

Yes

Office Use Only

Conflict of Interest Check Completed	Yes	No	N/A
Service Details	Legal advice	Legal task	Non-legal support
Contact Type	Phone	Face to face	Post / email
	Video conferencing	Other
Referrals	1/	2/
	3/	4/

If referred to MRCLC – client is to ring and book another appointment.
Simple / Facilitated referral?

Financial Disadvantage Indicator	Yes - cannot access funds	Yes - Centrelink benefit	Yes - other
	No	Not applicable	Non-legal support

DETAILS OF LEGAL PROBLEM AND ADVICE: SEE ATTACHED FILE
NOTE STOP: Must state Yes, No, N/A or Expired

Limitation Date	Yes	No	Date:
Client Advised?	Yes	No
Interpreter Used	Yes	No	Language
At Legal Advice Evenings	Yes	No	N/A
Legal Aid Status	Applied, waiting	Applied, refused	Exceeded Cap
	Not Applied	Not Applicable
Risk of homelessness?	Yes	No
Public interest?	Yes	No

Advisor's Name	Signature	Date

Supervisor's Name	Signature	Date

GIVE ME A CALL:

MACKAY REGIONAL COMMUNITY LEGAL CENTRE (MRCLC)
CONFIDENTIAL CLIENT ADVICE FORM – GENERALIST

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Generalist Form

MACKAY REGIONAL COMMUNITY LEGAL CENTRE (MRCLC)CONFIDENTIAL CLIENT ADVICE FORM – GENERALIST

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MACKAY REGIONAL COMMUNITY LEGAL CENTRE (MRCLC)
CONFIDENTIAL CLIENT ADVICE FORM – GENERALIST