Fitzroy Legal Service Enquiry Form

Night Service Advice Clinic

If you are seeking general legal advice, we can assist you through our Night Service Advice Clinic. The clinic is volunteer run, and we provide both face to face and phone appointments at our Fitzroy and Reservoir offices. Appointments occur each weeknight and each appointment is approximately 40 minutes in duration.

Please note this service is for a Legal Advice appointment only. In most cases we cannot represent you in court. See here for information from Victoria Legal Aid about going to court: Legal Aid: Going to Court.

Areas of law that our legal advice clinic can provide advice on:

• Animal law, including;
  • Criminal prosecutions by council for dog attacks
  • Ownership disputes
• Complaints, including;
  • Identifying who or what organisation a complaint relates to, and what process are involved in making a complaint
  • Responding to a complaint made about you
• Consumer law
• Criminal law
• Debt (either owed to and by a client)
• Discrimination
• Employment law
• Family law
• Family Violence Intervention Orders (FVIO)
• Fines, including;
  • Public transport fines, toll fines, parking fines, traffic infringements
• Insurance
• Motor Vehicle Accidents
• Personal Safety Intervention Orders (PSIO)
• Tenancy, including;
  • Breach of landlord's duties, rent increases, repairs, quiet enjoyment issues, notice to vacate, rental arrears
• Victims of Crime (please note we can only provide basic advice and referrals)
• WorkCover, including;
  • The process for applying for WorkCover and what entitlements may be available

Please complete the form below to enquire about an appointment with Fitzroy Legal Service.

All questions marked * are compulsory.
All data collected will be kept private and confidential in accordance with our Privacy Policy.

If you have a support person they can help you fill out this form, or contact our Reception on (03) 9419 3744 for assistance.

How did you find out about our night advice clinic? (Please select) Referred by another service Spoke to FLS Reception Google Search Social Media Other

If referred, please name the service that referred you to us

First Name

Last Name

What are your pronouns? Please Select She/her He/him She/they He/they They/them Other N/A Prefer not to disclose

For more information about pronouns visit this site - What Are Pronouns and Why Are They Important?

What other names are you known by (if any) ?

What is your Date of Birth

What gender do you identify with? Please select Male Female Agender Brotherboy Genderfluid Gender non-conforming Genderqueer Gender questioning Intersex or Intermediate Non-binary Not Stated Other Pangender Prefer not to disclose Sistergirl Transfeminine Transgender person Transmale Transmasculine Transwoman

From the options below, which best describes your living situation Please select Community Housing Couch surfing Crisis/transitional Home owner Other Private rental Public housing Rooming house Rough sleeping Supported Housing In custody Living in Family home (Parent Renting) Prefer not to disclose

What is your Street Address

What Suburb are you in ?

What is your Postcode ?

What area of law do you need help with? (Please select) Animal law  (Civil dispute or Council charges) Civil Complaints (I would like to make a civil complaint about someone and or I would like to make a Complaint about someone eles) Consumer law (Complaint about a product or service I have Purchased) Criminal law (I have been charged with an alleged criminal offence) Debt (I owe money or someone owes me money) Discrimination Employment law and Workcover Family Law Family Violence Intervention Orders Fines or Infringements Personal Safety Intervention Order Motor Vehicle Accidents Tenancy/Housing Victims of Crime / Financial assistance scheme Other/ unknown

What is the legal issue(s) you are seeking advice about? (Please provide as much detail as you can in a few lines)

Please provide the full name and DOB of the individual you are in dispute with OR the full name of the company/organisation you are in dispute with.

If you do not know the name of the other party, we may not be able to help you. If someone has started a legal action against you, and you have paperwork about this, check this to find the details of the person or organisation taking legal action against you. If you have been charged with a criminal offence, please include the names for any victim or witnesses referred to in the brief of evidence. We will not contact the people listed under any circumstance.

Do you have any paperwork relevant to your legal matter? (Please select) Yes No

To help you with your legal matter we need you to provide us with the paperwork before your appointment. If you do not have the paperwork, we might ask you to get it before we can book you into an appointment. If you have the paperwork please send to reception@fls.org.au and include your name and date you submitted this enquiry

Do you have an upcoming court hearing? Please select Yes No Unknown

What court is your hearing listed at? Please Select Heidelberg Magistrates' Court Neighbourhood Justice Centre Collingwood Melbourne Magistrates' Court, Melbourne County Court Other Unknown

Are you currently employed or working? Please select Yes No Workcover Prefer not to disclose

Do you receive Centrelink? Please Select Yes - Centrelink is main or only source of income Yes - However earning more from other income sources No Unknown Prefer not to disclose

If Yes, what centerlink payment type do you receive? Please Select NA Newstart DSP Youth Allowance Age Pension ABSTUDY Veterans Benefit Parenting Payment Carers Payment AUSTUDY Job Keeper Job Seeker Family Tax Benefit Other Prefer not to disclose

What is your weekly after tax income (Centrelink is included as income)? Please select No Income $1 - $199 (after tax) $200 - $299 (after tax) $300 - $399 (after tax) $400 - $599 (after tax) $600 - $799 (after tax) $800 - $999 (after tax) $1000 - $1249 (after tax) $1250 - $1499 (after tax) $1500 - $1999 (after tax) $2000 or more (after tax) unknown Negative Income Prefer not to disclose

What is your current relationship status? Please select Single Married/DeFacto Separated Divorced Widowed Prefer not to disclose

If Married or De facto what is your combined weekly after tax income? Please select $1-199 (after tax) $200-299 (after tax) $300-399 (after tax) $400-599 (after tax) $600-799 (after tax) $800-999 (after tax) $1000-$1249 (after tax) $1250-$1499 (after tax) $1500-$1999 (after tax) $2000 or more (after tax) N/A (Not married or defacto) Partners income not known Prefer not to disclose No Income No access to partners finances due to family violence

Which best describes your family situation? Please select Not applicable / No Children Sole parent with dependent children Two parent family with dependent children Children residing with other parent Children residing with non parent family Children in state care Adult children only Primary guardian of dependant child Prefer not to disclose

If applicable, please enter the number of children under 18 in your care

Please enter N/A if not applicable

Are you experiencing or at risk of homeless? Please Select Yes No At risk of Prefer not to disclose

Are you of Aboriginal or Torres Strait Islander descent? Please select Aboriginal Torres Strait Islander Neither Both Unknown Prefer not to disclose

Do you have a disability you’d like us to know about? Please select Yes No Prefer not to disclose Unknown

What disability do you have? Please Select Not Applicable Autism Blood borne Developmental Head injury/Stroke/Brain injury Intellectual Neurological Other Physical Psychological Psychiatric Sensory- Speech Sensory- Hearing Sensory- Visual Prefer not to disclose Unknown

What is the main language you speak at home?

Do you require an Interpreter? Please Select No Yes (Language interpretation) Yes (Auslan interpretation)

Do you wish to have a LGBTQIA+ (Lesbian, Gay, Bi, Transgender, Queer, Intersex, Asexual) lawyer to assist you with your matter? Please Select Yes No

Please respond 'No" if you do not identify as part of the LGBTQIA+ community.

What is your sexuality? Please select Gay Lesbian Bisexual/Pansexual Asexual Aromantic Straight Other (record in file notes) Prefer not to disclose

Are you Trans? Please select Yes No Prefer not to disclose Unknown

Are you Intersex? Please select Yes No prefer not to say Unknown Prefer not to disclose

Contact number

Email Address

Is it safe to leave you a voice mail? Please select Yes - Safe to leave VM No - NOT SAFE to leave VM Not Applicable (Not at risk of family Violence)

Is it safe to text you? Please select Yes - Safe to leave Text No - NOT SAFE do not text Not Applicable (Not at risk of family Violence)

I consent to being contacted by Fitzroy Legal Service via either Text, Call, Voicemail or Email (Please select) No (if this is selected we will not contact you, you must contact us on 9419 3744) Yes

I understand that FLS is required to collect, store, and use my personal information (For detailed information on how your information is collected stored and used, please read our privacy policy)

This field is required, if you require further information on how your data is used by FLS, please contact us on 9419 3744