Make a referral

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Make a referral

If you would like to refer a young person to see the youth lawyer, please download and submit the following referral form or simply fill the form in online (scroll below).

Referral Form

I consent to being contacted to arrange an appointment with the youth lawyer at Ballarat Community Health.

Please note that all appointments will be subject to a conflict check.

Conflict of interest check

Youthlaw conducts a mandatory “conflict of interest” check. We cannot assist someone if a legal conflict of interest exists. For example if we have previously assisted the other party to your specific legal dispute we are unable to assist you. A legal conflict of interest occurs when the duties a lawyer owes to his or her client come into conflict with the duties a lawyer owes to the court, to a different client or with the lawyer's personal interests.

Youthlaw Ballarat Referral Form

Use to refer a young person with a legal problem to Youthlaw Ballarat.

The compulsory fields are denoted by an asterisk *

Worker's Details

* Name:

* Email/Phone:

Organisation:

Young Person's Details

* Name:

* Date of birth:

(dd/mm/yyyy)

* Please provide at least one of the following contact methods (Phone, Email, or Address).

Phone:

Email:

Address:

Young person has consented to referral:

Yes No

Date:

(dd/mm/yyyy)

Other Party/Parties' Details

Person/s or organisation/s the young person is in conflict with.

This information is needed to conduct a conflict check. If Youthlaw has a conflict we will not be able to assist the young person. Instead, we will notify the worker and provide suggestions for other lawyers who may be able to assist.

Party one, name:

Date of birth:

(dd/mm/yyyy)

Address (if known):

Party two, name:

If there are more than 2 additional parties, please provide any additional party's in the textarea below.

Date of birth:

(dd/mm/yyyy)

Address (if known):

I agree that the information I have provided is current.

Make a referral

Referral Form

Youthlaw Ballarat Referral Form

Worker's Details

Young Person's Details

Other Party/Parties' Details

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