Solicitors Referral Form

Solicitors Referral Form

This is the most straightworward way to refer clients to Family Mediation. If you wish to refer a dispute to Civil/Commercial Mediation or to Workplace Mediation, it is better to call our main office on 01392 678010 and one of the mediators will call you directly to discuss further.

Please fill in the form below. Once completed simply press send and a copy of the form will be emailed back to you for your records. Alternatively follow the instructions in the right hand box for other methods of sending the form to us.

Fields marked with * are required.

1. Step 1
2. Step 2
3. Step 3
4. Check & Submit

Your Client's Details

Client's name:*

Client's address:*

Postcode:

Client's daytime telephone number:

Client's mobile telephone number:

Client's email (if known):

Your Details

Your name:*

Name of firm:*

Your address:*

Postcode:*

Your email address:*

Direct telephone number:*

Fax no:

DX no:

Reference:

Proceed to Step 2

1. Step 1
2. Step 2
3. Step 3
4. Check & Submit

Details of Other Party

Other Party's name:*

Other Party's address:*

Postcode:

Other Party's email (if known):

Other Party's Solicitor's Details, if represented

Contact at other party's solicitors:

Other party's solicitor:

Solicitor's address:

Postcode:

Daytime telephone no:

Email address (if known):

Back to Step 1 Proceed to Step 3

1. Step 1
2. Step 2
3. Step 3
4. Check & Submit

Please indicate the following

Is this family or civil mediation?

Family Civil

If family does it include?

Finance Children

Please provide brief details of the issues. If a family mediation, please alert us to any other relevant information e.g. personal safety of clients or mediator, drugs or alcohol misuse, court proceedings, social services involvement etc.

Back to Step 2 Proceed to Step 4

1. Step 1
2. Step 2
3. Step 3
4. Check & Submit

Submit referal form

May we add your email address to our list for future information mailings

No Yes

Read our privacy policy

We will send a copy of the completed form to you via email for your records

Back to Step 3