Fill in the form below. Compulsory fields are marked *.

Your Details (Client)

* Name

* Address

* Telephone

Email

Your Solicitors Details (if appointed)

If the mediation proceeds we will confirm the appointment details with your Solicitor.

Solicitor's Name

Firm Name

Reference

Address

Telephone

Email

Other Party's Details

Please provide the details of the other party below. We will contact the other party directly.

Name

Address

Telephone

Email

Other Party's Solicitor's Details (if known)

Solicitor's Name

Firm Name

Reference

Address

Telephone

Email

Other Details

* Preferred venue for mediation:

* Issues for mediation:

Are there any court proceedings or injunctions?

Any other relevent information?