Enquiry for mediation

Submitting this confidential form will allow us to provide you with further information so that you can decide a preferred way to resolve your situation.

Please answer the questions as openly as you are able. We will contact you to discuss the options for you.

Costs: If you are on low income, we align our charges with the legal aid fee structure to ensure that mediation is accessible to all.

We understand the need for your privacy and treat all matters with utmost confidentiality.

Email address *

Personal Details

This part of the form covers the current situation for the individual making the enquiry

What is your name? *

Your answer

Your phone number? *

Your answer

Any particular privacy needs for how or when we contact you?

Your answer

What do you need to resolve?

Property

Family (between family members e.g. inter-generational, LGBT, separation etc.)

Community (With other people e.g. neighbours etc)

Tradesman (With a Company e.g. contractor, supplier or provider of services)

Other

What is your current level of dissatisfaction with the matter? *

Low

High

Who are you in dispute with?

Your answer

A brief description of the matter:

Your answer

Thank you

We will contact you shortly in line with your privacy needs.

A copy of your responses will be emailed to the address you provided.

Submit

Never submit passwords through Google Forms.

Forms

reCAPTCHA

Privacy Terms

This form was created inside of The Resolution Centre.