Request for Mediation Form
Thank you for your interest in mediation services from the Vital Village Network.

Please fill out this form below and we will contact you soon, usually within 3-5 business days.

Alternatively, feel free to call on Tuesdays between 12 noon and 1 PM at 617-414-3640. We're interesting in helping you and if we're not able to do so with our mediation services, we will help you find other resources in the community. If you have any questions, please email us at
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Your name *
Email address *
Phone number *
Will you need any extra accommodations to help you participate such as an interpreter or wheelchair accessibility? If yes, please list.
Please indicate which SJMP service you are interested in
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