General Mediation Forms and Worksheets

Prior to mediation you must fill out these forms:

For Everyone

Agreement to Mediate Form
The Agreement to Mediate sets some basic rules and an understanding of how the mediation process will evolve and what it can and can’t do for you. This required form must be signed before we can begin our discussion. Download this form ↓
Issue Identification Form
Identifying the issues that are important will help us to focus on your priorities for our session. Download this form ↓

Intake Questionairre

For Everyone

Please choose the form that applies to your situation, A or B.

A. General Mediation Intake questionnaire
The Intake Questionairre helps me to be aware of your life position and needs so that I can give you the best service possible. This form is to be completed and sent to me before your scheduled appointment. Download this form ↓
B. Mediation Intake Questionnaire For Court Mandated Mediation
Please fill out this form when an attorney or the court system has asked for or mandated your mediation. It includes the necessary data to complete the process. Download this form ↓

For All Mediation Involving Children

Questionnaire for Mediation Involving Children
If your mediation will involve issues with children, please fill out and submit this form prior to family mediation or adult mediation. This clearly alerts me to areas of discussion on the issues that concern age related behavior and expectations. Download this form ↓

For Issues Involving Custody, Separation And Divorce

Comprehensive List of Parenting Issues
Use this form to help you identify and prioritize possible parenting issues in family separation/divorce. Please use this as a guideline to sort through the best possible solutions for your family circumstances. Download this form ↓

If you have questions about the forms, please contact The Mediation Mentor »