Mediation Intake Form

Welcome to our Trauma-Informed mediation practice. Please provide your information and help us understand your mediation needs.

First name

Last name

Email address

Phone number

Case alignment

Both agree to mediate

Mostly agree

High conflict

How aligned are both parties regarding mediation?

Asset discussion

Fully discussed

Partially discussed

Not started

What is the current status of asset discussions between parties?

Priority timeline

Within 30 days

1-3 months

Just exploring

What is your preferred timeline for beginning mediation?

Expert selection priorities

I value Trauma-Informed guidance

I value emotional safety

I am price-focused

What matters most to you in selecting a mediator?

Virtual Mediation