Schedule a Mediation with CMS - Request Form
To schedule a mediation, please provide as much of the information below as you have available. The parties or their attorneys will be contacted by CMS within two business days regarding scheduling.
Today's Date: *
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Subject Matter of Dispute:
Case Information (if a lawsuit has been filed)
Case Name:
(i.e. Smith vs. Jones)
Court Civil Action Number:
(i.e. 2017C00123)
Courtroom:
Party Requesting Mediation - Contact Information
Requesting Party's Name: *
(Please provide first and last name)
Phone Number:
Email Address:
Attorney Information (if applicable):
Please list the Attorney's NAME, PHONE and/or EMAIL ADDRESS
Are there additional people associated with your side of the dispute? *
Other Party's Information
Other Party's Name: *
(Please provide first and last name)
Phone Number:
Email Address:
Attorney Information (if applicable)
Please list the Attorney's NAME, PHONE and/or EMAIL ADDRESS
Are there additional people associated with your side of the dispute? *
Additional Information
Have all parties agreed to participate in Mediation with CMS? *
By what date must the mediation be completed (if applicable)?
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If Parties have pre-selected date(s) & time(s) for Mediation, please indicate your First Choice:
NOTE: Mediations conducted at the courthouse MUST be scheduled after 12:00pm
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Time
:
If Parties have pre-selected date(s) & time(s) for Mediation, please indicate your Second Choice:
NOTE: Mediations conducted at the courthouse MUST be scheduled after 12:00pm
MM
/
DD
/
YYYY
Time
:
If Parties have pre-selected date(s) & time(s) for Mediation, please indicate your Third Choice:
NOTE: Mediations conducted at the courthouse MUST be scheduled after 12:00pm
MM
/
DD
/
YYYY
Time
:
Comments:
If there is any additional information you feel is important to note, please enter it here.
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