MATHEWS LAW MEDIATION INTAKE FORM

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Please complete this form prior to attending mediation with Lisa Mathews. This form is confidential and will not be shared with the other party in the mediation. Please note that Lisa Mathews is an attorney, but she does not provide legal advice to any mediation clients. Mediation is not considered the practice of law in Virginia and as such, Mathews Law does not give legal advice in mediation. Lisa Mathews can provide legal information of which she has knowledge, but not legal advice. You are encouraged to consult an attorney for any legal advice or prior to signing any mediation agreement.

What is your name?

How old are you?

What is your email address?

What is your phone number?

What is your occupation?

What is the other party's name?

Please describe the circumstances that have led you to pursue mediation.

Please list the issues that you wish to be discussed and/or decided in this mediation.

Please describe the goals that you have for mediation including any desired outcomes if an agreement is reached.

Would you prefer to meet in person or via Zoom?

In person (conference room)

Zoom

Clear selection

If you chose "in person" above, do you have any concerns about being in the same room as the other party?

Is there anything about your relationship that would prohibit you from being able to speak freely in the presence of the other party? If yes, please explain.

Please state anything else that you wish the mediator to know prior to the mediation.

Submit

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