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If you would like to refer a young person to see the youth lawyer, please complete and submit the following referral form.

Conflict of interest check

Youthlaw conducts a mandatory “conflict of interest” check. We cannot assist someone if a legal conflict of interest exists. For example if we have previously assisted the other party to your specific legal dispute we are unable to assist you. A legal conflict of interest occurs when the duties a lawyer owes to his or her client come into conflict with the duties a lawyer owes to the court, to a different client or with the lawyer's personal interests.

Referral Form

I consent to being contacted to arrange an appointment with the youth lawyer at Ballarat Community Health.

Please note that all appointments will be subject to a conflict check.

The compulsory fields are denoted by an asterisk *

Your details


* Please provide at least one of the following contact methods (Email, Address, or Phone Number).

Other party details

The person or entity that you are in dispute with (e.g. John Smith, Company Name, Bank, Police, your ex-partner).


I agree that the information I have provided is current.