Mediation Referral Form

Our mediation services are designed to help you find amicable resolutions in a supportive and structured environment.

Our mediation sessions cost £200 plus VAT for 1½ hours of mediation per party. This fee structure ensures that both parties receive the necessary time and attention to work towards a constructive outcome.

Important Update on Fees
Please note that as of 1 July 2024, our fees for a Mediation Information and Assessment Meeting (MIAM) will be £120 plus VAT.

Client 1

Name

Address

Postcode

Date of birth (DD-MM-YYYY)

Mobile number

Phone number

Special needs?

Funding

Any history of domestic abuse

Details of any court proceedings

Court welfare or any other Social Agency involvement

Preferred office

Issues to be discussed

Client suitable for mediation?

Yes

If no, please provide details

3rd party referral

Any referral needed at this stage, i.e. counselling or legal advice.

Further relevant information

Client 2

Name

Address

Postcode

Date of birth (DD-MM-YYYY)

Mobile number

Phone number

Special needs?

Funding

Any history of domestic abuse

Details of any court proceedings

Court welfare or any other Social Agency involvement

Preferred office

Issues to be discussed

Client suitable for mediation?

Yes

If no, please provide details

3rd party referral

Any referral needed at this stage, i.e. counselling or legal advice.

Further relevant information

Solicitor for Client 1

Name

Address

Postcode

Phone number

Reference

Source of referral

Further relevant information

Solicitor for Client 2

Name

Address

Postcode

Phone number

Reference

Source of referral

Further relevant information

We’ll only use this information to handle your enquiry and we won’t share it with any third parties. For more details see our Privacy Policy.

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