request for mediation

If you would like to start mediation, you can do this on line by completing this form.

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.
1) Your details
Your full name
Your Address
Postcode
Your day time phone number
Your email address
2) Details of other party
Other party's full name
Other party's Address
Postcode
Other party's day time
phone number
Other party's
email address (if known)
4) If other party represented by solicitors, solicitor details:
Contact at other party's solicitors
Address of other party's solicitors
Postcode
Other party's solicitor's direct phone number
Other party's solicitor's
fax number
Other party's solicitor's
email address
4) Please indicate the following:
Is this family or civil mediation?
 Family   or Civil
Brief details
How do you wish to be contacted:
email phone letter
May we add your email address to our list for possible future information mailings?
 YES NO