Divorce Mediation Intake Form

MEDIATION INTAKE FORM

First, please review the Consent to Joint Orientation and the Rules below.

Rules for Mediation Orientation

1. Mediation is a voluntary process. No one can be “forced” into mediation. Both parties must agree, and be present, to use mediation.
2. In mediation, we are functioning as neutral facilitators.  Thus, even though we are attorneys, we will not be acting as you or your ex’s attorney, in any capacity.  While confidentiality protects mediation, there shall be no attorney-client privilege.
3. Neutrality is central to mediation. Thus, we will not communicate with either of you without the other party’s knowledge or consent.  Please copy each other on all correspondence.
4. Though we strongly believe mediation is the BEST way to resolve disputes, it may not be appropriate in the following scenarios:
a. When one party refuses to mediate;
b. If there is domestic violence in your matter;
c. When one or both parties is hiding assets;
d. When one or both parties refuse to negotiate fairly or is otherwise acting in bad faith.

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Mediation requires both parties to willingly participate. As a neutral mediator, I cannot persuade someone to join the process—that’s a conversation for you and your spouse. If your response is no, please explore our blog for tips on discussing mediation, or book a paid consultation to discuss your options.
Mediation is a voluntary process. No one can be “forced” into mediation. Both parties must agree, and be present, to use mediation.
Party 1: I have reviewed and understand the Disclosure and Waiver of Privilege, as well as the Disclosure and Waiver of Conflict of Interest, and I consent to the Joint Orientation.
The Joint Mediation Orientation shall not proceed until both parties have read the Disclosure and Waiver of Privilege, as well as the Disclosure and Waiver of Conflict of Interest.
Mediation is a voluntary process. No one can be “forced” into mediation. Both parties must agree, and be present, to use mediation.
Party 2: I have reviewed and understand the Disclosure and Waiver of Privilege, as well as the Disclosure and Waiver of Conflict of Interest, and I consent to the Joint Orientation.
The Joint Mediation Orientation shall not proceed until both parties have read the Disclosure and Waiver of Privilege, as well as the Disclosure and Waiver of Conflict of Interest.
If yes, please list the names of your attorneys.
If yes, please provide case number.
Please indicate if this is disputed.
If yes, please provide names and DOB for all children.
If this is disputed, please indicate what each party desires.
If yes, please specify.
If employed, please provide name of employer, position, salary/earnings, employment benefits, retirement benefits.
If employed, please provide name of employer, position, salary/earnings, employment benefits, retirement benefits.
Please indicate Description, Date of Acquisition, Present Location, Source and Nature of Consideration, Purchase Price, Current Fair Market Value and Encumbrances
Please indicate Description, Date of Acquisition, Present Location, Source and Nature of Consideration, Purchase Price, Current Fair Market Value and Encumbrances
Please indicate Description, Date of Acquisition, Present Location, Source and Nature of Consideration, Purchase Price, Current Fair Market Value and Encumbrances
Amicable/contentious?
Please note that if there is a history of violence, mediation is probably not appropriate.
Please specify