Criminal Charges, Drink Driving, Drug Charges, Limited Licences, Work Licences and Assault Charges

Client Details Questionnaire

Personal Details

First Name:

Middle Name:

Surname:

Date of Birth:

Address:

Email Address:

Home Phone:

Mobile Phone:

Work Phone:

Charges

What are you charged with:

Date of Last Court appearance and what happened:

Next Court Appearance Date:

Court:

Other Problems Requiring Assistance:

How Can I Help:

Authority to Access Your Records and Information:

If the matter is urgent and you think I may need to access your Police and Court records as a matter of urgency before we can arrange an appointment please enter a fax number in the space below. We will fax you a form authorising us to contact the Police and access your records on your behalf. Please sign the fax and fax it back to us.

Fax number for Authorisation Form: