Mediation Referral Form

*Please be assured that the information you provide will remain confidential until an agreement to mediate has been signed

YOU

YOUR SOLICITOR'S DETAILS

THE OTHER PERSON INVOLVED OR PERSON YOU WANT TO MEDIATE WITH

(even if this is a sole MIAM, we need to know the name of the other person in the relationship)

THEIR SOLICITOR'S DETAILS

DETAILS

Children
Property/Finances
Divorce/Separation
Communication

Please confirm we can proceed to invite you and the other person to a mediation information and assessment meeting

Would you like the New Enquiries Team to give you a call