LEGAL HEALTH CHECK (MENTAL HEALTH)

Please Note:Completing this document does not create any obligation between you, the client or any legal service. The Legal Health Check identifies potential legal need. Please view the training module at www.legalhealthcheck.org.au for details.

Client Name

Community Agency

Worker Name

Date

Legal Service

Address

Appointment Time

1. Money Troubles (Debt)

Is anyone chasing you for money?

Yes No Unsure

Do you have payments due or unpaid accounts? E.g. phone //Centrelink // Cash converters //electricity //car loan Complete the table below for each debt, where possible.

Yes No Unsure

Would you like to access your superannuation or insurance cover?

Yes No Unsure

Debt	Creditor (who you owe $ to)	Amount owed (approx)	Instalment Payment amount and frequency	Contact Are you being contacted by phone? E.g. by debt collector?
e.g.	Telco	$2500.00	$100pfn	yes
1
2
3

Add More

2.Unpaid Fines and Crime

Do you have any unpaid fines (e.g. SPER/ SDR/ CCV)?

Yes No Unsure

Would you like to explore your options? E.g. smaller instalments// Work orders// Waivers?

Yes No Unsure

Are you due in Court or have any outstanding warrants in your name?

Yes No Unsure

DETAILS

3.Housing Concerns

Have you recently been evicted?

Yes No Unsure

Was your tenancy bond lodged and retured?

Yes No Unsure

Did you leave any belongings behind at recent accommodation?

Yes No Unsure

Do you have any unpaid rent?

Yes No Unsure

Are you or do you want to apply for government or community housing?

Yes No Unsure

Are you on any tenancy blacklists e.g. TICA?

Yes No Unsure

DETAILS

4.Centrelink and Decision-making

Are you receiving the appropriate Centrelink benefits?

Yes No Unsure

Are you under a Forensic or Involuntary Treatment Order?

Yes No Unsure

Does the Adult Guardian look after your personal or health affairs?

Yes No Unsure

Does the Public Trustee make decisions about your money?

Yes No Unsure

Would you like to change or review any of these arrangements?

Yes No Unsure

DETAILS

5.Relationships Would you like to discuss..?

Domestic violence orders you want, have or are subject to?

Yes No Unsure

Arrangements, plans or orders about children? (e.g. who the child/ren live with, spend time with, or your involvement in major long- term issues)

Yes No Unsure

State child protection orders or concerns about you or any children?

Yes No Unsure

Your rights in any personal relationship, including divorce or separation?

Yes No Unsure

Concerns about your experiences as a child, while you were in the care of adults or institutions?

Yes No Unsure

DETAILS

6.Employment and Business

Have you signed any business contracts which you are concerned about?

Yes No Unsure

If you are/were employed:

Are you satisfied that your wage and conditions are fair (e.g flexibility to attend study or care for children)?

Yes No Unsure

Did you receive all your entitlements when you left (e.g. annual leave)

Yes No Unsure

Do you believe you were unfairly dismissed?

Yes No Unsure

Was your mental health negatively impacted by your work?

Yes No Unsure

DETAILS

7.Other

Do you have any other concerns that you would like to raise with a lawyer?

Yes No Unsure

Completed Legal Health Checks are not stored on the website or in any associated cloud technology. If you keep a copy of a completed Legal Health Check, it is subject to your organisation's privacy obligations.