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Personal Information
Where are you located?
Calgary
Edmonton
Other
Mention the name of other location:
*
First Name:
*
Last Name:
*
Date of Birth (dd/mm/yyyy):
*
Address:
*
Email Address:
*
Cell Phone:
*
Home Phone:
Work Phone:
Please check the number that are approved for voice messages?
*
Cell Phone
Home Phone
Work Phone
May we leave voice mail messages at these phone numbers?
*
Yes
No
What type of program/ service do you require?
Civil Claims Duty Counsel
Queen’s Bench Amicus Court
For more information click here
Civil Claims Duty Counsel
Queen's Bench Amicus Court
How do you wish to receive assistance?
Telephone
Videoconference
Case Information
I am the:
*
Plaintiff
Defendant
Please list all of the Plaintiff’(s) names relating to this matter: (full names of all individuals, company names and trade names)
*
Please list all of the Defendant’(s) names relating to this matter: (full names of all individuals, company names and trade names)
*
Please list any other persons or companies that might be involved in your matter:
*
Do you have an upcoming court date. If so, when?
Date
Time
:
HH
MM
AM
PM
What is the nature of that appearance?
*
Motion
Trial
Mediation
Pre-Trial Conference
Other
Do you need to create court documents today?
*
Yes
No
Maybe
Do you need services in another language?
*
Yes
No
If yes, which language:
Additional Information
In one sentence, briefly tell us what your case is about. Why are you suing or being sued?
*
What are your 3 main questions?
1)
*
2)
*
3)
*
1. Do you have any other cases pending at this moment?
*
Yes
No
2. Does the opposing party have a lawyer or representative?
*
Yes
No
Unsure
3. Do you currently have a lawyer or other representative currently helping you with this case?
*
Yes
No
4. Has a lawyer ever assisted you with this case?
*
Yes
No
If yes, why is that lawyer no longer assisting you?
Is this your first meeting with a Duty Counsel lawyer through this program?
*
Yes
No
I HEREBY REPRESENT THAT THE information that I have provided is true and accurate to the best of my knowledge and belief.
Print name:
*
Date (dd/mm/yyyy):
*
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