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All Families Mediation
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HOME
ABOUT
WHAT IS FAMILY MEDIATION?
OUR SERVICES
MIAM
FAMILY MEDIATION SESSIONS
CHILD INCLUSIVE MEDIATION
COURT FORMS
TERMS AND CONDITIONS
BOOKING/PRICING
RESOURCES
BLOG
CONTACT US
Your Title:
Mr
Mrs
Miss
Ms
First Name:
Last Name:
Email:
Date of Birth:
Address:
Tel / Mobile:
National Insurance No:
Occupation:
Best way to contact you:
Brief Background Information:
Title:
Mr
Mrs
Miss
Ms
Full Name:
Address:
Date of Birth:
Email:
Tel/Mobile No:
Date Started Living Together:
Date of Separation:
Date of Marriage/Civil Partnership:
Date of Decree Nisi (Conditional Order):
Date of Decree Absolute (Final Order):
Are you currently involved in divorce, ending a civil partnership or child/ren proceedings?
Yes
No
Are you consulting a solicitor? If so, please give us their name, address, and telephone number:
If yes, what stage have they reached?
Do you have a new partner?
Are you living together?
IMPORTANT: Have there been any incidents of Domestic Abuse:
Child 1:
Date of Birth:
Age:
Gender:
Male
Female
Any Special Needs:
Child 2:
Date of Birth:
Age
Gender
Male
Female
Any Special Needs:
Child 3:
Date of Birth:
Age
Gender
Male
Female
Any Special Needs:
With whom are the children currently living? Please briefly outline the current arrangements for the children:
If you are separated from the other parent, are the children in contact with both parents?
Do you have Parental Responsibility for your children?
Yes
No
Not Sure
Is Parental Responsibility an issue between you and your partner/former partner?
Yes
No
Outline of issues you wish to discuss: Your children:
Yes
No
Not Sure
Your money/property:
Yes
No
Not Sure
Divorce/separation:
Yes
No
Not Sure
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