Before You Complete the Intake Form
This intake form is used to determine whether mediation appears to be an appropriate fit for your situation and to begin the scheduling process.
Completing the form:
- Does not commit either party to mediation.
- Does not replace legal advice or representation.
- Helps the mediator understand your goals, timeline, and any safety considerations.
Please answer as accurately as you can. If a question does not apply, you may leave it blank.
What the Form Will Ask You
- Contact details for both parties (names, email, phone).
- Case status (county, case number if any, attorneys involved).
- Children (whether you have children together and their ages).
- Main issues you hope to address in mediation (parenting, support, property, etc.).
- Safety and communication concerns, if any.
- Scheduling preferences (days, times, format such as Zoom).
The actual form below uses these same categories so both parties can provide the essential information in a clear, organized way.
What Happens Next
After you submit this form:
1. Your information will be reviewed for conflicts and to see whether mediation appears appropriate for your situation.
2. If mediation seems like a good fit, you’ll receive an email with proposed dates and basic session guidelines.
3. If a brief pre-mediation call is recommended, you’ll be given scheduling options for that as well.
4. Once a date is confirmed, both parties will receive written instructions on how to prepare and what to expect.
Mediation is voluntary. Each person may consult with an attorney at any time for legal advice about their rights and obligations.