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Client 1

Details

ApplicantRespondent


Interview

Please complete as fully as possible, e.g. working hours, flexibility, etc.


Solicitor's details (if applicable)


Legal

Legally aided YesNoNot sure

Liable to pay fees YesNoNot sure

Client 2

Details

ApplicantRespondent


Interview

Please complete as fully as possible, e.g. working hours, flexibility, etc.


Solicitor's details (if applicable)


Legal

Legally aided YesNoNot sure

Liable to pay fees YesNoNot sure


Court Proceedings

Please give details, including court and hearing date.


Key Dates


Children

Child #1

Child #2

Child #3

Child #4


New Partner


Outline Of Situation

Is there a history of domestic violence? YesNo

Is there a history of child protection issues? YesNo

Has Cafcass or local authority Children's Social care been involved now or previously? YesNo


Areas for mediation

Please tick main issues.

Pre-separation issuesChild arrangementsPost-divorce problemsReaction to divorce/separationFinance and propertyOther


Is other party aware of referral? YesNo