Family Assessment Form

A booking will only be accepted if the following is provided:

✔ Copy of the relevant Orders and/or joint letter confirming agreement of the parties to attend the assessment

✔ Complete contact details for the parties’ and their legal representatives (please do not leave this information blank)

✔ Confirmation in writing that funds are readily available to pay the Expert’s fee for the assessment and report

Acknowledged *

Please indicate if any of the following apply to this Family Law matter

Have there been / are there allegations of violence, threats, or firearm offences? Including domestic violence and / or coercive controlling violence?

Yes

Have there been / are there allegations of drug and alcohol abuse?

Yes

Have there been previous complaint proceedings against professionals involved in the case to date? E.g., child protection services, lawyers, health professionals etc.

Yes

Have there been / are there allegations of child sexual abuse?

Yes

How many children are to be interviewed?

Please provide their full name and age (for multiple children, please list all names and age separated by a comma). *

Are there any additional people to be assessed including extended family members?

Yes

If yes, please provide their name and what their relationship to the child/children is
(Please note that it is at the discretion of the Single Expert whether these people will be interviewed)

Please advise what days of the week the child/children are typically with each parent.

Are their funds in trust/readily available to pay for this report?

Yes

Please confirm how you would like our fees to be invoiced

Split equally between the parties

The applicant is responsible for the whole amount

The respondent is responsible for the whole amount

Applicant’s Details

Full Name *

Date of Birth *

Mobile Number *

Email Address *

Applicant’s Legal Representative Details

Full Name

Firm Name

Contact Number

Email Address

Respondent’s Details

Full Name

Date of Birth

Mobile Number

Email Address

Respondent’s Legal Representative Details

Full Name

Firm Name

Mobile Number

Email Address

Independent Children’s Lawyer (ICL) Details

Full Name

Firm Name

Mobile Number

Email Address

Family Assessment Form

A booking will only be accepted if the following is provided:

Name of matter and court reference

Are you seeking

Do you wish to engage a specific clinician?

Please indicate if any of the following apply to this Family Law matter

How many children are to be interviewed?

Are there any further details you wish to include?

Are there any further details you wish to include?

Applicant’s Details

Applicant’s Legal Representative Details

Respondent’s Details

Respondent’s Legal Representative Details

Independent Children’s Lawyer (ICL) Details

Please review your entries before submission.

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