Legal Referral Form

Name *

First

Last

Phone

Email *

Address *

County of Residence

Please select the county you would like to receive your referral in.

Date of Birth (month/day/year) *

Preferred Method of Contact *

Phone
Email
No preference

Please 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? *

Yes
No

If 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? *

Yes
No

Do you have any upcoming appeal/court deadlines *

Yes
No

If you answered yes to the previous question, please enter your next upcoming court/appeal date below

If your problem is a family or criminal law matter, have you contacted Nova Scotia Legal Aid? *

Please 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 car
Yes, if appointment location is accessible by public transportation
No, I will require virtual (Zoom) or telephone appointments

Is this your first referral with reachAbility Association? *

Yes
No

If you answered no to the previous question, please describe your past engagement(s) with reachAbility:

How did you hear about reachAbility? *

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