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Application for legal services

This form may be used to make a request for legal assistance.

Part A is for older adults who are contacting us on behalf of themselves.

Part B is for service inquiries by an agency, relative, friend or other third party.

We will respond to your inquiry by email. You must provide an email address where we can contact you to submit this form.

If you do not have an email address please call our Seniors Help and Information Line at 604-437-1940 or 1-866-437-1940.

Please provide your email address (required).

PART A

Please complete Part A only if you are an older adult who is applying on behalf of yourself.

Please confirm that you contacting us on behalf of yourself.

Yes, I am.

Are you age 55+?

Yes, I am.

What is your name?

What city/town do you live in?

What is your phone number?

Please provide a brief description of the problem:

PART B

Please complete Part B only if you are making a service request as an agency, relative, friend or other third party.

Please confirm that you are making a service request as an agency, relative, friend or other third party.

Yes, I am.

If you are an agency, please provide the name of your organization or service:

Are you are a relative or friend?

Yes, I am.

If you ARE a relative or friend, are you the legal representative of the older adult?

Yes, I am.

If you ARE NOT the legal representative please explain why you are making this contact instead of the older adult:

If you ARE the legal representative, describe the legal document that declares you the legal representative of the older adult (eg. power of attorney) AND why the older adult needs a legal representative (eg. not capable of managing affairs):

What is your name?

Name of the Older Adult:

What city/town does the Older Adult live in?

BC Centre for Elder Advocacy & Support

Application for legal services

PART A

PART B

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