To request a mediation, please fill out the form below, OR print and mail this PDF form.

  • Please follow up with payment to complete your mediation request.

  • Party Initiating mediation request:

  • What is a support person?
  • Party Responding to mediation request:

  • Please fill in the following ONLY if you have an attorney AND they will be attending the mediation. Requesting attorney is responsible for coordinating 3 mutually agreeable dates and times.
  • Attorney for Initiating Party

  • Attorney for Responding Party

    If yes, copy of current orders are required with this form.
    Please upload a copy below.
  • After you select a file from your computer, the file will upload when you submit this completed form ("Submit Mediation Request Form" at the bottom of this page.)
    See all types and fees, and a comparison chart (pdf document):
    Mediation Services Comparison Chart
    Fee Adjustment Requests

    Payment must accompany this form.

  • Please enter a value between 0 and 25.
  • For Settlement Conference only:

  • Please list 3 dates and times, which are 4 weeks out from the date of your payment.

    Monday - Thursday: 9:00 AM, 1:00 PM, 5:30 PM

    Friday: 9:00 AM, 1:00 PM

    Saturday: 10:00 AM

  • Payment: