Mediation referral form for solicitors

Our mediation referral form is the most straightworward way for solicitors to refer clients to Family Mediation. Please fill in the mediation referral form below. Once completed, simply press send and a copy of the form will be emailed back to you for your records.

If you wish to refer a dispute to Civil and Commercial Mediation or to Workplace Mediation, it is better to call our main office on 0330 320 7600 and one of our mediators will call you directly to discuss further. Prefer to print and send? Download a PDF copy of our mediation referral form

Fields marked with * are required.

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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:

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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):

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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.

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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

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