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FORMS TESTING

Have you received advice from our Centre before?(Required)

About You

Your Name(Required)
Gender(Required)
DD slash MM slash YYYY
Are you a male defendant in an AVO proceeding?(Required)
Your Address
Are you homeless or in temporary accommodation?(Required)
Your Email Address(Required)
Do you identify as
Do you speak a language other than English at home?
How well do you speak English?
How well do you write in English?
Do you have special needs due to a disability?
Relationship status?
Employment(Required)
Living arrangements(Required)
Home Ownership(Required)
Are you currently, or have you recently, experienced DV or FV?(Required)
Name(Required)
Email(Required)
Please give a brief description of the problem you are having.
Have you received advice from our Centre before?(Required)

About You

Your Name(Required)
Gender(Required)
DD slash MM slash YYYY
Are you a defendant in an ADVO proceeding/Domestic Violence related charges?(Required)
Your Address
Are you homeless or in temporary accommodation?(Required)
What is your preferred method of contact?(Required)
To help ensure your safety we will only contact you during the timeframe specified using your preferred contact method.
Your Email Address(Required)
Do you identify as
Do you speak a language other than English at home?
Do you need an interpreter?
Do you have special needs due to a disability?
Relationship status?
Employment(Required)
Living arrangements(Required)
Home Ownership(Required)
Are you currently, or have you recently, experienced DV or FV?(Required)

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