Your DetailsTitle*(Mr/Mrs/Miss etc.) Name* First Name(s) Surname Relationship to Other Person* Telephone Number*Email Address* Other Person's DetailsTitle*(Mr/Mrs/Miss etc.) Name* First Name(s) Surname Relationship to Other Person* Telephone Number*Email Address* Reason for MediationWhat are you wanting to discuss/resolve in mediation?*Tick all that apply Child related matters Property & Financial matters Other Discuss/resolve - otherAppointmentsPlease specify at which location you would like to attend your mediation meeting* Harrogate Liversedge AccessPlease advise us of any special requirements you may need (i.e. wheelchair access, interpreter etc.)Please tell us who completed this form*MyselfMy SolicitorCAFCASSOther (please specify by giving contact name and number)Form completed byIf selected 'other' in previous answer please specify. CommentsPlease let us know if you have any additional comments or queries.CAPTCHA
