Name of person completing this form (if a paralegal, please enter your name and the name of the attorney participating in mediation): *
Your answer
Pursuant to the Standing Order from the ADR Office, all domestic case parties or their attorneys MUST complete the mandatory screening questionnaire BEFORE scheduling mediation. The link to the questionnaire: https://godr.org/adr-screening/ *
Civil Action # / Case #: *
Your answer
Case name (Example: Jane Doe vs John Doe): *
Your answer
I am / I am representing: *
Choose
A Plaintiff in the case
A Defendant in the case
My telephone number is: *
Your answer
If you're representing a party on this case, provide their email address:
Your answer
If know, please provide the other's party's email address.
Your answer
If you're representing a party on this case, provide their telephone number:
Your answer
If known, provide the other party's telephone number.
Your answer
What is the status of your case? *
Name of Attorney Participating in Mediation and their email address (if self-represented, leave blank)
Your answer
A copy of your responses will be emailed to the address you provided.