Solicitor Referral Form

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Solicitor Referral Form

Referring clients with confidence
- All the information you supply will be treated with absolute confidentiality and will not be passed beyond our mediation team or discussed with any other parties without your agreement. * (asterisk) indicates required fields.
- * Your full name
- * Name of firm
- Your address
- Postcode
- Your direct phone number
- Your fax number
- * Your email address
- DX Number
- Reference
- All the information you supply will be treated with absolute confidentiality and will not be passed beyond our mediation team or discussed with any other parties without your agreement. * (asterisk) indicates required fields.
- Client's Name
- Clients address
- Postcode
- Client's daytime phone number
- Client's Email (if known)
- All the information you supply will be treated with absolute confidentiality and will not be passed beyond our mediation team or discussed with any other parties without your agreement. * (asterisk) indicates required fields.
- Other Party's Name
- Other Party address
- Postcode
- Other Party daytime phone number
- Other Party Email (if known)
- All the information you supply will be treated with absolute confidentiality and will not be passed beyond our mediation team or discussed with any other parties without your agreement. * (asterisk) indicates required fields.
- Contact at other party's solicitors
- Solicitor's address
- Postcode
- Daytime phone number
- Email Address(if known)
- Is this a MIAM referral?
  Yes
  
  No
- Will you wish to receive CW5 (Help with Mediation)?
  [Legal Aid contract firms only]
  Yes
  
  No
- * Is this a case involving allegations of domestic abuse?
  *If yes please give details below
  Yes
  
  No
- *Domestic abuse allegations
- All the information you supply will be treated with absolute confidentiality and will not be passed beyond our mediation team or discussed with any other parties without your agreement. * (asterisk) indicates required fields.
- Is this family or civil mediation?
  Family
  
  CIvil
- If family does it include
  Children
  
  Finance
  
  Both
- Whether your client or the other party are likely to be eligible for publicly funded mediation
  Yes
  
  No
- Please alert us of any safety risk to our staff or the parties
- May we add your email address to our list for possible future information mailings?
  Yes
  
  No
- * Please enter the code shown

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