We are currently experiencing higher-than-average caseloads and apologize that most cases that open

right now can expect extended wait periods of at least four to six weeks before they are able to mediate.

We appreciate your patience and will do our best to meet your mediation needs as quickly as possible.

Individual Forms

Mediation Referral

Name of Referring Agency:

Name of Referral Personnel:

First Name *

Last Name *

Name:

First Name *

Last Name *

Mailing address:

Country

Address Line 1 *

City *

State/Province *

Postal Code *

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Phone Number:

Email Address:

Name:

First Name *

Last Name *

Other Participant's Phone Number:

Names of any Additional Participants:

Please separate participant names with commas

Relationship(s)/Association(s) Between Participants:

Briefly Describe Why this Case is Being Referred to Mediation

Is this there a case in court associated with this referral?

Consent to Mediate Signed Document(s):

If you or your office have signed consent forms for this process please include here where possible.

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