> Appointment Enquiry Form

Appointment Enquiry form

please enter the Full names of each party to the mediation and their full contact details

Party One

First name: *

Surname: *

Phone: *

Email: *

City: *

Lawyer name: *

Lawyer firm: *

Lawyer phone: *

Lawyer email: *

Lawyer city: *

Party Two

First name: *

Surname: *

Phone: *

Email: *

City: *

Lawyer name: *

Lawyer firm: *

Lawyer phone: *

Lawyer email: *

Lawyer city: *

Additional Information

Preferred date for mediation: *

Preferred location of mediation meeting: *

Payment of mediation fees by choose: *

Shared Equally
Party One
Party Two

Items to be discussed: *

Property
Parenting
Both Property and Parenting

Booking made by: *

Booking contact number: *

Any other related details: *

Have both parties agreed to the mediator, date and, if applicable, preferred venue? *

Yes No

Security code: *

Are you ready to get help with mediation or family dispute resolution?