Court Appointed Mediations

Your Name*

First Last

First and Last Names as they appear on court documents.

Your Email*

Your Phone*

Your Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have an attorney?*

Yes

No

Not yet

Your Attorney's Name*

Opposing Party's Name*

First Last

First and Last Names as they appear on court documents.

Opposing Party's Email

Opposing Party's Phone

Opposing Party's Address

Street Address Address Line 2 City State ZIP Code

Does Opposing Party have an attorney?*

Yes

No

Not sure

Opposing Party's Attorney*

Your next hearing's date

What is the hearing regarding?*

Are there any current restraining orders?

Yes

No

Which party is protected?*

Preferred Language

Referred by

Preferred Dates / Times (please list 5)*

We must limit the number of court appointed Mediations to two a month, therefore, we may not be able to schedule your Mediation before your next court date.*

I understand and acknowledge.

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Schedule Your Court Appointed Mediation