Pre-Mediation Form

Are you ready to get started with mediation? Please fill out our Pre-Mediation Form below, so that we can serve you best! Please fill in all fields of the form to ensure your application goes through.

What is your challenge?

Is there a reason your partner would not want to mediate?

What would happen if you don't mediate? or you don't resolve your challenge?

Best Date for our Pre-Mediation Consultation

BASIC INFORMATION

Name *

First

Last

Main Phone

Cell / Work Phone

Email *

Birth Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Spouses Name

First

Last

Spouses Birth Date

Spouses Email

Spouses Phone

MARRIAGE INFORMATION

What was the date of your marriage?

When did you start living together?

Are you living in the family home?

Does your spouse live with you?

Do you think your spouse is open to mediation?

Have you seen a lawyer for this issue?

Do any of the parties work outside of Kelowna?

Are there any legal reasons that may prevent you from communicating directly or indirectly (restraining order, peace bond?)

CHILDREN INFORMATION

Are there children from this relationship?

ADDITIONAL INFORMATION

Are there any mental or physical disabilities in the family?

Have you recently had an episode of physical violence?

Is there anything else we should know?

How did you hear about Family Mediation Center?

Linkedin-in Facebook-f