Referral Form

If you are interested in talking to us about mediation, please complete the form below and a member of our Mediation department will contact you.

Your/Your clients details

Full Name Please enter your name

Address Please enter your address

Postcode

Contact telephone number Please enter your telephone number

Do you want your address to be kept confidential?

Yes No

Solicitors details (if applicable)

Solicitors Name

Firm Name

Address

Postcode

Telephone number

The other parties details

Full Name Please enter the other parties full name

Relationship to you (your client):

Address Please enter the other parties address

Contact telephone number Please enter the other parties telephone number

Solicitors details (if applicable)

Solicitors Name

Firm Name

Address

Postcode

Telephone number

Details of Current Dispute

Please give a brief description of the issues (Please include names and ages of children, if applicable)

Please provide any other relevant information about which the mediator ought to be aware.

IT IS ESSENTIAL THAT YOU GIVE DETAILS OF ANY DOMESTIC VIOLENCE/CHILD PROTECTION/MENTAL HEALTH ISSUES.

Is the other participant aware of this referral to mediation?

Yes No

Are there court proceedings relating to the dispute?

Yes No

Are either of the parties likely to be eligible for Legal Aid?

Yes No Dont know

Please enter the verification code

We’ll only use this information to handle your enquiry and we won’t share it with any third parties. For more details see our Privacy Policy

How can we help?

- - Claire Buckley
  - Partner - Head of Family Department
- - 01202 306260
  - View profile
- - Karen Andrews
  - Senior Associate Solicitor
- - 023 8021 3781
  - View profile
- - George Chick
  - Trainee Solicitor
- - 01962 624460
  - View profile
- - Pauline Ellis
  - Senior Associate Solicitor & Mediator
- - 01202 466669
  - View profile
- - Andrew Kirkconel
  - Consultant Solicitor
- - 01962 624414
  - View profile
- - Jonathan Whettingsteel
  - Associate Solicitor
- - 01962 624405
  - View profile

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