NOCO Mediation Intake Form
Date
*
I am
*
an attorney or paralegal scheduling mediation.
not represented by an attorney and would like to schedule a free virtual 30-minute mediation consultation.
Your first name
*
Your last name
*
Your email
Your phone
Case Number, if applicable
Client's first and last name
Client's prior names
Client's email
Other party's first and last name
Other party's prior names
Other party's email
Other party's phone
Other Party's attorney name, email, and phone
List any past or current affiliation with Erin Redmond Claeys or the NOCO Mediation center
What issues are you looking to mediate?
Preferred date for initial consultation
Preferred mediation date
Preferred mediation time
:
HH
MM
AM
PM
Desired second mediation date
Desired second mediation time
:
HH
MM
AM
PM
Desired third mediation date
Desired third mediation time
:
HH
MM
AM
PM
Have these dates been cleared with the other party?
Yes
No
Preferred mediation location
Virtual
In-person
Physical limitations of either party