Shine | Epsilon Law

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Shine

CLIENT REFERRAL FORM

Please fill in the referral form.

This form will be forwarded to the staff of Epsilon Law and Manisha Saini for review and action.

We will be in touch!

Step 1 of 4

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Referral / Referee Details
Referral Date*
Shine Branch*
Shine - Other*
Name of Shine Representative*
First Last
Position of Shine Representative*
Mobile of Shine Representative*
Email of Shine Representative*

Client Details
Client's Name*
First Middle Last
Is the Client in a Safehouse?*
Where is the Safehouse located?*
Client's current or last known Address*
Street Address Suburb City ZIP / Postal Code Country
Client's Contact Number*
Client's Email address*

Client Brief
Has the Client been referred to another lawyer?*
Name of Lawyer the Client has been referred to?*
First Last
The Client needs assistance with the following matters.*
- Select All
- Family Law
- Immigration
- Other
Brief/Comment on Family matter.*
Brief/Comment on Immigration matter.*
Brief/Comment on Other matter.*
Does the Client speak English?*
What language is the Client fluent in?*
Will the Shine Representative be able assist in and/or organise an Interpreter?*

Documents
Do you wish to upload any documents?*
What documents would you like to upload?*
- Select All
- Case Brief
- Police Safety Order (PSO)
- Other
Upload - Case Brief*
Upload - Police Safety Order (PSO)*
Upload - Other Document*
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