Creative Mediation Case Intake Form
The purpose of this form is to allow members of the community to open a mediation case with us via the internet.

If you have any questions about whether a situation is appropriate for referral, please do not hesitate to call our office to speak with a dispute resolution specialist.

(805-549-0442)

Upon receipt of your completed Intake Form, you will be contacted by Creative Mediation to initiate your case.

 
  1st Party Information
Name:
Street:
City:
State:
Zip:
Phone:
E-mail:
Language Spoken:

 

2nd Party Information
Name:
Street:
City:
State:
Zip:
Phone:
E-mail:
Language Spoken:
 


Why are you requesting mediation?