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Client Contact Form

Please fill in as much as you can, we will then contact you to discuss it or arrange your Mediation Information Assessment Meeting (MIAM) with one of our mediators.

Your Details:

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Other Party Details:

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Do you want some or all parts of this form kept confidential from the other party?
Do you want some or all parts of this form kept confidential from the other party?
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Are there any concerns about domestic or alcohol/drug abuse?
Are there any concerns about domestic or alcohol/drug abuse?
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Details of relevant Children:

Number of Children
Number of Children
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1st Child's Details

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Child's Gender
Child's Gender
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2nd Child's Details

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Child's Gender
Child's Gender
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3rd Child's Details

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Child's Gender
Child's Gender
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4th Child's Details

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Child's Gender
Child's Gender
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Issues for Mediation
Issues for Mediation
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Do you want information and to be assessed for Legal Aid for mediation?
Do you want information and to be assessed for Legal Aid for mediation?
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Details (if known) of solicitors advising in this matter:

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Do you or the other party have any additional needs? (e.g. interpreter or support worker)
Do you or the other party have any additional needs? (e.g. interpreter or support worker)
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Phone: 01273 694 661
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Office hours are 09:00 to 17:00 Monday to Friday