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    Client 1

    Details


    Interview

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


    Solicitor's details (if applicable)


    Legal

    Legally aided. Yes or No

    Liable to pay fees. Yes, No or Not sure

    Client 2

    Details


    Interview

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


    Solicitor's details (if applicable)


    Legal

    Legally aided. Yes or No?

    Liable to pay fees. Yes, No or Not 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

    Limited to 1000 characters

    Is there a history of domestic violence? Yes or No

    Is there a history of child protection issues? Yes or No


    Areas for mediation

    Please tick main issues.

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


    Is other party aware of referral? Yes or No