REFFERAL FORM FOR MEDIATION SERVICES

(for Mandatory Information Program Attendees- MIP)

FOR ALL APPLICANTS AND RESPONDENTS TO FAMILY COURT MATTERS

PLEASE COMPLETE THIS ONLINE FORM TO REQUEST INFORMATION ON FAMILY MEDIATION SERVICES OR TO REQUEST FAMILY MEDIATION

Peel Family Mediation offers offsite and onsite services at this court location.

Free onsite* family mediation services are available at this court location for OCJ and SCJ matters. This free service is only available to you if you are in family court. You may use onsite mediation services at any time during your court process including prior to your first court appearance.

Family mediation is a voluntary opportunity for you and the other party to resolve your court matters in a collaborative manner. A neutral and independent mediator will assist you to discuss and possibly resolve your issues relating to decision making/custody, parenting time, and child support, s.7 expenses, property division and spousal support.

If you are able to reach partial or full resolution, the mediator will prepare a summary report, which can then be used to create minutes of settlement to settle some or all of your court matters. It is important to note that not all cases are appropriate for family mediation, and your mediator will assess your suitability for this process. Consent by both the Applicant and Respondent are required in order to proceed with mediation.

Requesting an ONSITE FAMILY MEDIATION for family court litigants: Either Party (Applicant or Respondent) or your Legal Counsel may e-mail us to book an onsite mediation. Requests for onsite mediation should be made as soon as possible after your MIP.

* up to 4 hours including intakes, mediation time and report writing

Please fill out this form if you would like to be contacted to learn more about mediation or to open a referral for mediation services. A referral means we will explore the option of mediation with you and the other party.

Your name

Today’s Date

Are you the Applicant or Respondent? Are you the Applicant or Respondent? Applicant Respondent

Your phone number

Can we leave a message ? Can we leave a message ? Yes No

Your e-mail address

Court file number: (if available)

Are you in Superior or Ontario Court of Justice? Are you in Superior or Ontario Court of Justice? SCJ OCJ

Location Location Brampton court location Orangeville court location

14 + 6 =

Offsite mediation services are available for a fee (income sliding scale) and can be used when your onsite time has been expended and you may need more time. To inquire about offsite services, please contact us at irc@peelfamilymediation.org.