How can I request more information or book a mediation appointment?

Please tell us as much information about your situation below. We will be in touch shortly with more information on family mediation and how you can arrange a mediation appointment. Find out more about Family Mediation Vouchers.

1Your Info

2Other Party Info

3Legal Info

4Additional Info

5Confirm & Submit

Step 1: Your Information

Please enter your name and address details below.

Your Title (required)

Your First Name (required)

Your Surname (required)

Your Address

Address Line 1 (required)

Address Line 1 (required)

Address Line 2

Address Line 2

Your City (required)

City (required)

Your County (required)

County (required)

Your Postcode (required)

Postcode (required)

Your Email Address (required)

Your Telephone Number (required)

Your Alternative Number

Your Date of Birth

Step 2: Other Party Information

Step 2: Other Party Information

Please enter the name and address details of the other party which will be involved in the mediation process. Please provide as many details as possible.

Other Party Title

Other Party First Name

Other Party Last Name

Other Party Address

Other Party Address Line 1

Address Line 1

Other Party Address Line 2

Address Line 2

Other Party City

City

Other Party County

County

Other Party Postcode

Postcode

Other Party Email Address

Other Party Telephone

Other Party Alternative Number

Other Party Date of Birth

Previous PageStep 3: Legal Information

Step 3: Legal Information

Please enter the legal details pertaining to the mediation case. Please provide as much detail as possible.

Do you have a solicitor? (required)

• Yes
• No

Please provide your solicitor's details

Solicitor Company Name

Solicitor Contact

Solicitor Address

Solicitor Postcode

Solicitor Email

Solicitor Telephone

Please provide the other party solicitor's details (if applicable)

Other Party Solicitor Company Name

Other Party Solicitor Contact

Other Party Solicitor Address

Other Party Solicitor Postcode

Other Party Solicitor Email

Other Party Solicitor Telephone

Please tell us about any children involved in your case

Please include the names and ages of the children, who they live with and your relationship to them

Issues you want mediation to help you settle

• Children’s issues
• Property and/or Finance
• All Issues Mediation

Please give a brief outline of the issues you would like to resolve in mediation

Previous PageStep 4: Additional Information

Step 4: Additional Information

The more you are able to tell us now will help us tailor our services to meet your individual circumstances.

Your relationship to the other person (required)

Have you already, or do you intend to apply to Court? (required)

• Yes
• No
• Not Sure

If yes, is it (required)

• For the divorce
• To sort out child arrangements
• To sort out finances
• Other

Are there any court orders already in place? (required)

• Yes
• No

Are Social Services involved? (required)

• Yes
• No

Is there a history of domestic abuse or intimidation? (required)

• Yes
• No

Special Requirements

If you need us to make any special arrangements for you to access our services please tell us in the box below

Any additional Information

Please tell us anything else we should be aware of

How did you hear about us?02 – Solicitor03 – Court03.01 – PSU04 – CAB05 – Other advice agency or helpline05.01 – Mediation & More05.02 – Wikivorce05.03 – Other Mediation Service05.04 – Tanja Dodd06 – Relate or other relationship counselling07 – GP/NHS08.01 – TV/Radio08.02 – Newspaper08.03 – Website08.04 – Facebook08.05 – Twitter08.09 – Instagram08.06 – Other Social Media10.01 – Schools10.02 – Separating Better App Referral09 – Other10 – Unknown

Enter promo code (if applicable)

Previous PageStep 5: Confirm & Submit

Step 5: Confirm & Submit

Please double check your details before submitting. If you need to change any details, please use the “Previous Page” tab to return to the relevant step.

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