Case Appraisal Form Please enable JavaScript in your browser to complete this form. - Step 1 of 2Please complete the below appraisal form and we will be in contact with you shortly.Basic InformationFirst Name *Last Name *Phone *Email *How did you hear of ROG? *Click to select an optionGoogleLinkedInFamily & FriendsWord of MouthQueensland Law SocietyLegal Referral – please specify which firm or solicitorOther – please specifyWhich firm or solicitor referred you?Other - please specifyPreferred method of contact *Click to select an optionPhoneEmailWhat is the nature of your enquiry? *Click to select an optionDomestic ViolenceCriminal ChargesProfessional DisciplineCoronial MatterAppeal MatterBail ApplicationComplaint Against PoliceTraffic ChargesWorkplace Health & SafetyOtherYour selection will customise Step 2 of this form so we can assist you in the best way possible.NextCriminal Charges1. What is the charge or charges?2. When is your court date?If you fail to attend a Court date, a warrant may be issued for your arrest. If you have concerns about attending your Court date, please discuss them with one of our lawyers when we make contact with you.3. Where is your court date?4. What are the names of any co-accused? (required)5. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Professional Discipline1. What is your occupation?Click to select an optionDirectorCEOExecutive TeamEmployeeLegal ProfessionalMedical ProfessionalOther – please specifyOther - please specify2. What are the charges?3. What stage have the allegations reached?4. What are the names of the co-accused?5. Would you like to attach any documents? Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Appeal Matter1. When was the person convicted?2. Has a notice of Appeal been lodged?YesNoNOTE: THERE ARE STRICT TIMEFRAMESFOR APPEALS - YOU SHOULD CONTACT OUR OFFICE BY PHONE URGENTLY ON 07 3034 0000)3. What was the person convicted of?4. Did the person plead guilty or proceed to a trial?GuiltyProceed to trialOther5. What are the names of any related parties?6. Do you have anything further to advise?7. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Coronial Matter1. Has the coroner's preliminary investigation been undertaken?YesNo2. What is your relationship to the deceased?3. Tell us your concerns for the coroner4. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Domestic ViolencePlease tell us a bit about your DV situationI am the aggrieved in a DV situationI am the respondent to a DV applicationI am charged with Breaching a DV orderI am the aggrieved in a DV situation1. I am the aggrieved in a DV situation. What is the nature of your relationship to the other party?2. Who is the other party/ies in your matter?3. Is your application a police application or a private application?Police ApplicationPrivate Application4. When is your court date?If you fail to attend a Court date, a warrant may be issued for your arrest. If you have concerns about attending your Court date, please discuss them with one of our lawyers when we make contact with you.5. Where is your court appearance?6. Tell us about the DV you have experienced7. Tell us about any other aspect of the matter you are concerned about.8. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.I am the respondent to a DV application1. I am the respondent to a DV application. What is the nature of your relationship to the other party?2. Who is the other party/ies in your matter?3. Is your application a police application or a private application?Police ApplicationPrivate Application4. When is your court date?If you fail to attend a Court date, a warrant may be issued for your arrest. If you have concerns about attending your Court date, please discuss them with one of our lawyers when we make contact with you.5. Where is your court appearance?6. Tell us about the allegations7. Tell us about any other aspect of the matter you are concerned about.8. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.I am charged with Breaching a DV order1. I am charged with Breaching a DV order. What is the nature of your relationship to the other party? 2. Who is the other party/ies in your matter?3. What is the charge or charges?4. When is your court date?If you fail to attend a Court date, a warrant may be issued for your arrest. If you have concerns about attending your Court date, please discuss them with one of our lawyers when we make contact with you.5. Where is your court appearance?6. Tell us about the allegations 7. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Bail Application1. What is the charge or charges?2. Has bail been refused by a Magistrate?YesNo3. When is your court date? If you fail to attend a Court date, a warrant may be issued for your arrest. If you have concerns about attending your Court date, please discuss them with one of our lawyers when we make contact with you.4. Where is your court date?5. What are the names of any related parties?6. Tell us about the allegations7. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Complaint Against Police1. What is the nature of your complaint?2. Do you have any outstanding criminal proceedings?YesNoTraffic Charges1. What is the charge or charges?2. When is your court date?If you fail to attend a Court date, a warrant may be issued for your arrest. If you have concerns about attending your Court date, please discuss them with one of our lawyers when we make contact with you.3. Where is your court date?4. Tell us about the allegations5. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.Workplace Health & Safety1. Has the injury or incident occurred at work?YesNo2. Are you an employer or employee?EmployerEmployee3. Have Workplace Health and Safety Investigators commenced an investigation?YesNo4. What are the names of any related parties?5. Tell us briefly the nature of your concern6. Attach relevant documents (optional) Click or drag files to this area to upload. You can upload up to 5 files. You can upload up to 5 files. The max file size for upload is 10MB. PLEASE NOTE: Uploading senstive information is voluntary and you may choose to mail or deliver this material to our office. Please refer to our Privacy Policy which outlines how we handle your information.OtherTell us briefly the nature of your concern**OFFICE USE ONLY****OFFICE USE ONLY** NOTES ON CONVERSATION WITH CLIENT*STAGE MATTER IS AT*INITIAL EMAIL SENT*CLIENT AGREEMENT TO BE SENT*DATE OF CONFLICT CHECK (Secretary to do)*BASIS OF ENGAGEMENT*FURTHER ACTION REQUIRED (eg. Request QP9)*SOLICITOR NAME*AUTHORITY TO COMMUNICATE TO 3rd PARTY?*DATE OF BIRTH*ADDRESS*DATEGo backSubmit
