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THE Mediation Specialists for the East Midlands

 

01623 675845

Family Mediation Referral

It is easy to make a referral to Midlands Mediation.

Step 1 – Select the correct referral form by clicking on the relevant link below

Step 2 – Complete the form and save a copy for your own records

Step 3 – Attach and send it to us using the facility below

Step 4 – Let us do the rest!

REFER YOURSELF. If you wish to refer yourself to mediation or for an assessment, please download this form: Family Mediation SELF Referral Form 2011

REFER YOUR CLIENT. If you wish to refer your client to us for mediation assessment, please download this form: INITIAL MEDIATION REFERRAL FORM(2011)

Complete it, and send it back to us below:

Your Name (required)

Your Email (required)

Attach completed form

Additional Comments

We will confirm receipt and contact the parties involved to make appropriate arrangements.