Referral Form – Solicitors

Applicant

Other Party

Solicitor’s Details (if applicable)

Solicitor’s Details (if applicable)

Areas of Mediation (please tick appropriate box)

Children’s IssuesProperty and FinanceAll Issues (includes Children’s Issues And Property & Finance)

Further Details

Is this a MIAMS (mediation information and assessment meeting) referral?
(If mediation does not proceed, will you require a signed C100/FM1 for court purposes?)

YesNo

Are there any existing Court Orders?

YesNo

Are Social Services or CAFCASS involved?

YesNo

Is there a history of domestic abuse or intimidation?

YesNo

Does either party require an interpreter?

YesNo

Are you willing to wait in the same waiting room?

YesNo

Are any special facilities required?

YesNo

Which client would you like us to contact first?

BothApplicant onlyOther Party Only

Preferred Appointment Area

I understand that I will be expected to pay if I am not eligible for Legal Aid.

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