Solicitor Referral Form

If you would like to make an enquiry, please complete the form below. Fields marked with a * must be completed.

Your Details

Name*

Name of Firm*

Telephone*

Email*

Client Details

Name*

Address*

Telephone

Email

Other Party Details

Name*

Address*

Telephone

Email

The Referral

Is this a Referral Under the Funding Code?YesNo

Is this a MIAMS/FM1 Referral?YesNo

Would you like us to conduct a Willingness TestYesNo

The Willingness Test can only be conducted if the other party details are provided

Would your client prefer the meeting to be:--please select--With ex-partnerSeparateNo preference

Mediation type required*--please select--All IssuesChildren's IssuesProperty And Finance Issues

Does your client have concerns about safety during mediation?YesNo

Does your client have special needs?YesNo

If you have answered yes to either of the above, please provide additional information:

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