Family Mediation Intake Form
Using this form, please provide the requested information concerning your family situation and the items to be covered in the mediation. There is no obligation on your part until I have spoken with all the participants and agreed that I am to be your mediator.

If this is a mediation for something other than family matters (separation/divorce/parenting) please use this form instead: https://www.denvermediationservices.com/gen-intake
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Email *
Please fill out this form to get started. Only the first four questions are required, so please fill out as much as you can. There is no obligation and we will discuss your situation before we determine if I am to be the mediator.

The next few questions refer to the participant. If you are the participant's attorney, please complete the information for your client, and include your information afterwards.
What is the participant's name? *
What is the participant's address?
What is the participant's number?
In which state US state does the participant reside? Is the other participant in another state? Please provide details.
If the participant has an attorney, please provide their contact information.
What is the other participant's name?
What is the other participant's phone number?
What is the other participant's email address?
Does the other participant have an attorney? If so, please provide their name, number, and email address:
Does the other participant (or their attorney) know that you are seeking a mediator in this matter?
Clear selection
Will the other participant be willing to mediate?
Clear selection
Do I have your permission to contact the other participant, or their attorney? I will probably speak to you before I do so.
Clear selection
What are the issues to be resolved in mediation?
Have there been an instances in this situation of any of the following:
Please provide as much additional detail as you wish on any of the above questions. We will generally contact either the participant completing this form or their attorney, unless you tell us otherwise:
Mediation Scope and Disclaimer
No legal advice is given during any part of the mediation process.

A mediator can assist you in coming to agreement with the other participant(s) about certain aspects of your family law situation. A mediator can not provide any legal advice. The agreement reached by the participants will be written up and signed by all the necessary people. The mediator can not represent you in court. With respect to any legal paperwork that may have to be filed to ensure that the results of your agreement are properly implemented, we highly recommend that you obtain the services of at least one lawyer to help you put everything together.

Having said that, many divorce cases involve the use of a mediator and it is mandatory in some states to use a mediator if you cannot come to an agreement on your own. This statement is written for the purpose of explaining to you about the limits of a mediator's role.
Please write your full name in here to show that you understand and agree to the above statement: *
Thank you for your responses.  
Did you provide either a phone number or an email address, or both?  If so, I will contact you promptly. I look forward to working with you! Now please PRESS the SUBMIT button below!
Anthony Matthews, Mediator (720) 744-2689
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