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START YOUR FAMILY MEDIATION PROCESS
Please complete the form below, and we will get back to you as soon as possible to make arrangements for your Family Mediation process.
YOUR DETAILS
Name
*
Email Address
*
Mobile Phone
*
Land-line Phone
*
Street Address
*
Suburb
*
Post Code
*
State
*
QLD
ACT
NSW
NT
SA
TAS
VIC
WA
How would you prefer to be contacted?
*
Phone
Email
Please provide a brief summary of the dispute
*
What are you hoping to resolve at mediation?
*
Children's care arrangements
Communication with children
Communication between parents
Relocation of children
Child support
Property settlement
Changes to current Parenting Orders
OTHER PARTY'S DETAILS
Name
*
Email Address
*
Mobile Phone
*
Land-line Phone
*
Street Address
*
E.g. 980 Vulture Street
Suburb
*
Post Code
*
State
*
QLD
ACT
NSW
NT
SA
TAS
VIC
WA
How did you hear about us?
*
Google (General Search Result)
Google (AdWords)
Bing (General Search Result)
Yellow Pages
Yellow Pages Online
Solicitor
Family or Friend
ACCEPTANCE
I understand that this form is my application to start Family Mediation, and that by submitting this form, this process is commenced pursuant to and with full acceptance of the
Terms of Use
and
Costs
. An invitation to attend mediation will be sent to the other party by François.
PRIVACY NOTICE: The information provided on this form will be used to evaluate the suitability for a conference. Your information will not be given to any person or third party agency unless you provide us with written permission or we are required by law to make disclosure. For more information, please refer to our
Privacy Policy
.
To accept, please click on the check-box below
*
I agree.
Start Mediation Process
By Francois Mercier
