Request for Services Intake Form
Mediation is a voluntary process that is entered into upon agreement of both parties. This organizations is does not enter into legal representation of any kind. This document is strictly confidential, and is provided as part of a confidential (closed) mediation process. The only exceptions are if a child is at risk of harm, if any person is in imminent danger, or if a judge orders disclosure of this information. Please complete the sections of this form to the best of your knowledge and with as much detail as possible. You will be directed to subsequent sections based on your answers to the questions below.
Email *
Please select the service that you are contacting us about today. *
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