Intake Form

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The information you provide below is used to determine your eligibility for services through Lethbridge Legal Guidance.

You can also complete your intake by calling our office at 403-380-6338, or by visiting our office in-person at 423 5 St S.

Once you submit the form, our staff will follow up with you within the next business day.

Personal Information

First name*

Middle name

Last name*

Gender*

Preferred pronouns

Birthday*

Year

Month

Day

Address*

Address - Line 2

City*

Postal Code*

Can we send mail to this address?*

Yes

Phone*

Can we leave voice messages at this phone number?*

Yes

Email*

Can we send messages to this email?*

Yes

What is your current marital status?*

How many children under the age of 18 do you financially support? *

How many adults currently live with you?*

This includes spouses, roommates, friends, relatives, etc...

How much is your personal income per month, before taxes?*

Please include how much you are paid from all sources.

(Employment, AISH, CPP, child support, etc...)

How much is your household's income per month, before taxes?*

Please include the income of anyone else living with you.

(Spouses, roommates, friends, relatives, etc...)

How much do you pay for your rent or mortgage per month?*

Do you have any major savings or investments?*

Yes

Legal Information

Please provide a brief explanation of your legal issue:*

Please provide the first and last name of anyone involved in your legal issue:*

This includes spouses, friends, relatives, landlords, bosses, etc...

Please provide any documents related to your legal issue:

Have you applied to Legal Aid Alberta?*

Yes

Do you currently have a lawyer?*

Yes

How did you hear about Lethbridge Legal Guidance?

Consent

By checking this box and clicking submit, you agree to the Privacy Policy.

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