Online Referrals

To make an online referral for a patient, please complete the following form. We will assess your inquiry within 24 hours (Mon – Fri) and get in touch to discuss further or make an appointment.

*This information is required.

Which Hospital are you referring from?*

Type of patient*

Client Name*

Client date of birth*

Client Phone*

Is it safe to contact the patient?*

Other party's name (if unknown please indicate)*

Other party's date of birth (if unknown please indicate)*

Areas of law*

**We do not practice in these areas of law and may refer these matters to other lawyers.

Other area of law

Brief outline of legal matter*

Is an interpreter required?

If an interpreter is needed, which language?

Other important information (e.g. mobility issues)

If staff referral, please complete the fields below:

Staff Name

Staff Phone

Staff Email

Preferred client contact method*