Enquiry Form

Please complete the form below.

This service is a Legal Advice Only clinic. We do not have the capacity to represent you in court.

Areas of law that we 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
• Consumer law
• Criminal law
• Debt (either owed to and by a client)
• Driscrimination
• Employment law
• Family law (please note that we only offer 45 min advice appointments so our scope is limited on what matters we can assist with)
• Family Violence Intervention Orders (FVIO)
• Fines, including;
  • Public transport fines, toll fines, parking fines, traffic infringements
• Insurance
• Motor Vehicle Accidents
• 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

All questions marked * are compulsory.
All data collected will be kept private and confidential.

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

Have you received assistance from Fitzroy Legal Service before? (Please select) No Yes

Were you referred to Fitzroy Legal Service by someone or an organisation? (Please select) No Yes

If Yes, who referred you?

Fitzroy Legal Service runs a clinic committed to providing safe and inclusive legal services to the LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer/ Questioning, Intersex, Asexual+) community. This clinic is open to all community members regardless of your legal issue.
Would you like an appointment with the LGBTQIA+ Clinic? (Please select) No Yes

First Name

Family Name

Date of Birth

What is your gender? (Please select) Cis woman Cis man Transwoman Transfeminine Sistergirl Transman Transmasculine Brotherboy Non-binary Genderqueer Genderfluid Gender non-conforming Gender questioning Pangender Agender Other Prefer not to say

What are your pronouns? (You can select more than one) (Please select) She/her He/him They/them Other

For further information on pronouns, please see: https://www.minus18.org.au/articles/what-are-pronouns-and-why-are-they-important

Address

Suburb

Post Code

Phone Number

Email Address

What kind of legal problem are you seeking help for? Please select Animal law Criminal law Family law Intervention order Civil law Employment law Tenancy law Other

Name of Person or Organisation in dispute with?

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

If there are any safety concerns regarding us contacting you for an appointment, please email reception@fls.org.au

Are you Aboriginal and/or Torres Strait Islander? (Please select) Aboriginal Torres Strait Islander Both Neither

Are you experiencing family violence? (Please select) Yes No At risk of

Are you experiencing homelessness? (Please select) Yes At risk of No

Are you living with a disability? (Please select) Yes No

If yes, what type of disability? N/A Sensory- Speech Sensory- Hearing Sensory- Visual Intellectual Physical Psychological Head injury/Stroke/Brain injury ABI Autism Developmental Delay Neurological Blood borne Undisclosed Other

Do you have any support needs?

What is your family situation? (Please select) Never Married/Single Married/DeFacto Separated Divorced Widowed Unknown (Not Stated/Not adequately described)

Do you have dependent children living at home? No Yes

How many dependent children do you have?

Are you working at the moment? (Please select) Yes No

Do you receive a Centrelink benefit? (Please select) Yes No

If yes, what type of payment? NA Newstart Youth Allowance DSP Age Pension ABSTUDY Veterans Benefit Parenting Payment Carers Payment AUSTUDY Job Keeper Job Seeker Family Tax Benefit Other

What is your weekly income after tax? (including Centrelink) (Please select) No Income Unknown $1 - $199 (after tax) $200 - $299 (after tax) $300 - $399 (after tax) $400 - $499 (after tax) $500 - $599 (after tax) $600 - $699 (after tax) $700 - $799 (after tax) $800 - $999 (after tax) $1000 - $1249 (after tax) $1250 - $1499 (after tax) $1500 - $1999 (after tax) $2000 or more (after tax)

What is the main language you speak?

Do you need an interpreter? (Please select) No Yes