Request a mediation meeting

Contact us on 020 8315 7460 for a confidential discussion
to see how we can best help you.

Request a mediation information & assessment meeting (MIAM)

To request an appointment please complete and submit the following form.

Your contact will be dealt with in strict confidence.

Please note, we do not contact the other party without your permission.

If you need additional information before completing this form, please call us on 020 8315 7460/020 3824 4780.

About You

Title
MrMrsMissMsOther

First Name

Last Name

Date of Birth

Your Address

About The Other Person

Title
MrMrsMissMsOther

First Name

Last Name

Date of Birth

Their Address


Issues for Mediation

Please indicate all that apply.

Reasons for Mediation
Contact Residence of childrenParental ResponsibilityFinance / PropertyOther (please detail)

Would you like an individual first appointment with the mediator or one jointly with the other person?
IndividualJoint

Do we have your permission to contact the other person now?
YesNo

Please indicate availability:

How did you hear about us?

Do you wish to make an application for Legal Aid?
YesNo