History

Case intake Form

Thank you for your interest in mediation. To start a case with us, please fill out the form below. We'll send out a welcome packet to both parties that contains a consent form and an application for reduced fees. Once we receive the documents from both parties, we'll reach out to schedule an Initial Private Session (IPS) with each of you.

Your Name

Your Email Address

Your Address

Your Phone Number

Your Attorney

Other Person's Name

Other Person's Email

Other Person's Address

Other Party's Phone Number

Other Person's Attorney

Court Ordered? Court Ordered? Yes, mediation was ordered by a court.

*Divorce/Custody/Parenting Plan Only* Children's Names and Ages, separated by a comma.

Briefly, tell us what brings you to mediation?

5 + 10 =

LARGE GROUP

610 J Street, Suite 100
Lincoln, NE 68508
402.441.5740
info@TheMediationCenter.org