Family Mediation Referral Form

The best way to find out more about family mediation and other alternatives is to arrange a mediation information and assessment meeting. Complete and submit this form and we will contact you to make the arrangements.

Alternatively, you can download the attached referral form as either a pdf or a Word file to complete and submit.

Your details











 


Other parties details









 


Your solicitor's details (if you have consulted one)









 


Other parties solicitor's details (if they have consulted one)









 


Childrens ages/genders

Boy Girl


Boy Girl


Boy Girl


Boy Girl


Other important information

Married
Cohabitants
Never lived together
Uncertain

Yes
No
Unsure

Yes
No
Unsure

Children issues
Financial issues
All issues

Yes
No

Yes
No

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Family Mediation Council Family Mediators Association College of Mediators Resolution College of Mediators Family Law Panel Sorting Out Seperation