Name * First Name Last Name Email * Name of other party * What brings you to mediation? * Check all that apply Divorce Custody Estate Elder Care Personal Injury Something else Please provide a general description of your situation. * Do you currently have a pending court date? * Yes No If so, when and with what judge? Have you secured the services of an attorney? * Yes No No, but I am actively looking If you have secured the services of an attorney, what is their name and at what firm do they practice? Do you have access to a high-quality internet connection? * Yes No Is/are there any relevant circumstance(s) your mediator should know about prior to mediation? * Thank you!
