Book Ask-A-Lawyer: General Consultation

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First Name

Last Name

Cell

Applicant's Name (First, Last) AND Safe Email Address (if email address is available)

Advocate's Name (First, Last) AND Email Address

Type of Victimization

Is Applicant involved in any current administrative or court cases related to abuse or assault? If so, please provide case numbers, upcoming meetings or court appearance dates.

Is client represented by a lawyer in any case related to domestic abuse, sexual assault, stalking or harassment?

Which of these best describes your legal issue?

Offender's Name, Date of Birth, AND Relationship to Applicant

(For Advocate) Applicant has been explained and, if requested, referred to housing

(For Advocate) Applicant has been explained and, if requested, referred to counseling services

(For Advocate) I have a signed "Release of Information" from the applicant allowing me to submit information to TESSA Legal Services.

(For Advocate) I have read and explained the following to the applicant: The information provided in this form is to determine eligibility for legal services only and does not create an attorney-client relationship.

I understand that confirmation of this appointment booking is subject to Darryl Glenn, or their law firm, completing a conflict check.