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Start Mediation Ltd
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Client Form for a MIAM, Family Mediation, Divorce Mediation or Parenting Mediation

By completing this form we will spend less time during your initial appointment asking you questions and more time helping you consider your options. Completed forms are kept confidentially by Start Mediation Ltd and any information you provide on this form will not be shared with anyone else without your permission (and we will discuss any exception to this with you). By submitting your completed form, you consent to your data being collected and stored.

Step 1 of 4 - Introduction

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  • This form can be saved after the completion of any page by clicking on 'Next'. This will save it so that you can come back and complete it later, but you must be using the same device and browser. Also, you must avoid clearing your browser's cache. After submitting it, a copy will automatically be sent to the email address you provide for yourself.

  • The content of this form will be treated confidentially. This means the information and data provided will not be disclosed to anyone else outside of Start Mediation Ltd unless you provide consent.

  • Please select at least one of the following.

  • Your details

  • NOTE: this is the address which a copy of this form will automatically be sent to.
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  • Details about the person you share a problem with or who you are in dispute with

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  • Children under 18 or still in full-time education or still dependant for other reasons, and other dependants

  • Child 1

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  • Child 2

  • DD slash MM slash YYYY

  • Child 3

  • DD slash MM slash YYYY

  • Child 4

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  • Child 5

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  • Do any of the following apply to you or your relationship with the other person?

  • The problem or dispute you want to discuss

  • Professional representation

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Company Registration Number

Incorporated in England and Wales as a private company under Company Number 10322756

VAT Registration Number

357 8751 50

Registered Office Address

The Hub,
Hubbard Way,
2 Civic Drive,
Ipswich,
Suffolk,
IP1 2QA,
UK.

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Phone

01473 487427

Opening Hours

Mon-Fri: 9am-5.30pm,
Sat: 10am-1.30pm,
Sundays and Public Holidays: Closed

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