THE Mediation Specialists for the East Midlands

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(2015)

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.

Alternatively, for more information, or to arrange an appointment with an expert mediation specialist, call 01623 706020 or email