Referral Type ProfessionalSelf Your details/ Client Details Name Contact Number Email Address Solicitors Details Other Party Details Name Contact Number Email Address Solicitors Details (if known) Is the mediation about: ChildrenFinance and PropertyBoth Have either party made any allegations of Domestic abuse? YesNo Do you or other party have any special needs? YesNo Do you or other party require disabled access? YesNo Will either you or the other party require an interpreter? YesNo Do you think you or the other party might be eligible for legal aid? YesNo Is the other party aware of the referral to mediation? YesNo Do you wish us to contact them at this stage? YesNo Are there any other issues you wish to make us aware of? I consent to the use of my data as set out in this website's Privacy Policy.
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