Legal Referral Form Please enable JavaScript in your browser to complete this form.Name *FirstLastPhoneEmail *Address *County of ResidenceAnnapolisAntigonishCape BretonColchesterCumberlandDigbyGuysboroughHantsHRMInvernessKingsLunenburgPictouQueensRichmondShelburnePlease select the county you would like to receive your referral in. Date of Birth (month/day/year) *Preferred Method of Contact *PhoneEmailNo preferencePlease indicate which contact method you'd like our legal service coordinator to contact you with about the details of the referral. Is there a disability you self-identify with? *YesNoIf you answered yes to the previous question, please briefly describe the nature of your disability:Have you received advice from a lawyer on this legal matter? *YesNoDo you have any upcoming appeal/court deadlines *YesNoIf you answered yes to the previous question, please enter your next upcoming court/appeal date belowIf your problem is a family or criminal law matter, have you contacted Nova Scotia Legal Aid? *Yes - they are currently processing my application.No - but I do not qualify for legal aid.No - I have never attempted to contact legal aid.No - but I know from a prior application that my income does not qualify.N/APlease select "N/A" if your problem is not a family or criminal law matter. Briefly describe your legal problem: *Under 500 words, please provide a brief description of your legal problem. Note that this is not everything you want the lawyer to know, it is meant to give us a sense of what your problem is about. Relevant Facts and Parties Involved *Please list the full names of people or groups in your legal matter so that a lawyer can perform a conflict of interest check. Please include as well any relevant facts not included in your brief description above.What are your three (3) main questions for the lawyer? *Do you require any accommodations for the consultation? *Consultations may take place over the phone or online.Do you have means of transportation to/from in-person appointments? *Yes, I have access to a carYes, if appointment location is accessible by public transportationNo, I will require virtual (Zoom) or telephone appointmentsIs this your first referral with reachAbility Association? *YesNoIf you answered no to the previous question, please describe your past engagement(s) with reachAbility:How did you hear about reachAbility? *Submit