Solicitor Mediation Referral Form Step 1 of 3 33% You Or Your ClientSalutation Mr Mrs Miss Ms Dr Other Name AddressPost Code Telephone Numbers Please specify work/home/mobile, etcEmail Address Date of Birth The Other PartySalutation Mr Mrs Miss Ms Dr Other Name AddressPost Code Telephone Numbers Please specify work/home/mobile, etcEmail Address Date of Birth About The MediationDoes The Case Concern Finances Children Both How Has The Case Been Referred? Solicitor Court Recommended Yourself Where Would Be The Most Convenient Location For The Mediation? If Solicitors Are Involved Please Tell Us Their DetailsReferring Solicitor's Name Firm Telephone Email DX Other Party's Solicitor's Name Firm Telephone Email DX Important InfromationIs The Other Party Aware Of The Referral? Yes No Is The Other Party Willing To Accept The Appointment? Yes No Don't know Has CAFCASS or any other relevant agency been involved either now or previously? Yes No Is There Any History Of Domestic Abuse Between The Parties? Yes No Details Of Any Pending Or Current Court ProceedingsIf Either Party Has Any Disability Please Let Us KnowIf You Have Any Other Information Please Let Us KnowIf You Are Having Difficulties With This Form Or Would Prefer To Call Please Do So On 0161 637 9050CAPTCHA
