First Name

Last Name

Your email address, so we can reply to you.

Your phone number, in case we have a question.

Name of Matter, surname and initial please.

Type of service Type of service Chapter 7 Single Expert Report Child Impact Assessment Specific Issues Assessment Mental Health Assessment Psychiatric Assessment Report Cross Examination Family Counselling Other/Unknown

Are there currently court proceedings underway? Are there currently court proceedings underway? Yes No

Is this matter on the Magellan list? Is this matter on the Magellan list? Yes No Unsure

Are there allegations from either party as to a history of violence? Are there allegations from either party as to a history of violence? Yes No Unsure

Are there allegations from either party as to sexual abuse? Are there allegations from either party as to sexual abuse? Yes No Unsure

Are there allegations from either party as to access to firearms? Are there allegations from either party as to access to firearms? Yes No Unsure

Which is the closest city or regional centre as preference for interviews? Which is the closest city or regional centre as preference for interviews? Sydney Gold Coast Melbourne Other

Number of children

Age of each child

Does any child or young person of this family have a diagnosis of developmental delay or disability? Does any child or young person of this family have a diagnosis of developmental delay or disability? Yes No Unsure

Any other information you would like to provide