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Enquire about your family mediation session with Ian today.

Units 20-21, 210 Queen Victoria Street
North Fremantle, 6159

0418 928 448

ian@moveon.com.au

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Your details

First Name

Last Name

Phone

Email

Message

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Your details

First Name

Last Name

Phone

Email

Other party

First Name

Last Name

Phone

Email

Mediation details

Do you want us to ask the other person if they are prepared to participate in mediation with you?

Yes

No

What issues you wish to deal with at mediation?

Financial settlement ONLY

Parenting/children’s issues ONLY

BOTH financial settlement AND children’s issues

Other

Do you and the other party have children?

Yes

No

Children

Name

DOB

Who will pay the mediation fee?

I will pay all of the mediation fee

The fee should be split equally

I want other party to pay the fee

Some other arrangement

Other arrangement

Are there any restraining orders in place?

Yes

No

Do the restraining orders restrain you or the other party?

Me

Other party

How do you want the mediation to be held?

In person

By video link

Telephone

Will either person require a support person or lawyer at mediation?

Yes

No

Maybe

What is your preferred date or range of dates for the mediation?

ASAP

Specific date/dates

Availability (Start Date)

DD slash MM slash YYYY

Availability (End Date)

DD slash MM slash YYYY

Preferred scheduling (specific time or day)

Availability (Other)

How did you hear about Move On Mediation?

Previous client

Social media

Legal advice

Other

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Move On Mediation

Units 20-21
210 Queen Victoria Street
North Fremantle, 6159

0418 928 448

ian@moveon.com.au

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