Step 1 of 2
Today’s date
Person requesting Mediation
Plaintiff/Claimant is the person who has the disagreement and request resolution. Defendant / Respondent is the person responding to the claimant’s request for resolution.
Please indicate who referred the dispute to mediation. (check all that apply)
Please indicate the type of dispute you are attempting to resolve.
Would you or anyone participating in mediation have a concern about sitting or being present in the same room with the other party in an effort to resolve the matter in dispute?