Contact Page - Submit a Mediation Request Form - Mediator Connect

Step 1
You and the other party need to agree on using mediation.
Step 2
Fill out our easy intake form below.
Step 3
We follow up to make sure we find the mediator that's the perfect fit.
Step 4
We schedule and the mediator holds the mediation.

Now that you've made sure that the other people involved in the dispute agreed to mediate, we are on to Step 2. Please complete our form and someone from MediatorConnect will follow up to confirm what you submitted and work with you to find the mediator that's the perfect fit.

"*" indicates required fields

Your Information

First Name*

Last Name*

Business Name

Address

Phone**

Email*

Opposing Side Information

First Name*

Last Name*

Business Name

Address

Phone

Email

Dispute Information

Is there a deadline for your mediation?*

Yes

No

What is the deadline date?*

Do you have desired dates in mind for the mediation? If so, please provide a range that would work best (Such as 10/10/2022 - 10/20/2022)*

Are you splitting the mediation fees?*

Yes

No

By checking this box you are confirming that the other party has agreed to mediation.*

Yes

No