Full Name

Date of Birth (DD/MM/YYYY)

Email Address

Confirm Email Address

Phone

Address

Start Date of Foster Care Approval (MM/YY)

End date of approval (if applicable, MM/YY)

Details of Problem

Date your complaint first arose (DD/MM/YY)

Have you sought advice from another lawyer about this complaint? Have you sought advice from another lawyer about this complaint? Yes No

If your complaint is about monies owed, how much is owed and how have you calculated this?

Do you have legal expenses insurance? Do you have legal expenses insurance? Yes No

How would you like your complaint resolved?

Is there any other relevant information you would like us to know about?