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 Email Phone Best time to call If you have a solicitor, please give details: About The Other Person Title MrMrsMissMsOther First Name Last Name Date of Birth Their Address Email Their Phone Number Best time to call If they have a solicitor, please give details: 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 I consent to having this website store my submitted information so they can respond to my inquiry.