Submit Mediation Request

If you have completed a hard copy version of this form please send to karol@d-elaw.com or upload at the bottom of this page

Asset 3@2x

 

DUFFEE + EITZEN MEDIATION FORM

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SECTION I. 

USE ENTER KEY TO SEPARATE ANSWERS IF THERE ARE MULTIPLE CHILDREN

SECTION II.

 

-For the purposes of this form:

"PT"  stands for Petitioner

"RD"  stands for Respondent

-When multiple items are required  use the enter key within the specified box to separate the answers

PETITIONER (PT)

PLEASE LIST: ATTORNEY NAME AND EMAIL.   
PLEASE LIST:  1. FIRM NAME 2. MAILING ADDRESS 3. PHONE  and 4. FAX
PLEASE LIST PARALEGAL NAME AND EMAIL

RESPONDENT (RD)

 

PLEASE LIST: ATTORNEY NAME AND EMAIL.   
PLEASE LIST:  1. FIRM NAME 2. MAILING ADDRESS 3. PHONE  and 4. FAX
PLEASE LIST:  PARALEGAL NAME AND EMAIL

SECTION III

MEDIATION INFORMATION
YYYY slash MM slash DD
HALF DAY=4 HOURS; FULL DAY=8 HOURS
Choose from our office, zoom, or off site.  Note: If you choose "Off Site" Please provide off-site location address in the box labeled "ADDITIONAL INFORMATION"
SELECT A DUFFEE + EITZEN MEDIATOR
Example: "I would like the mediation to be located off site at ___"
This field is for validation purposes and should be left unchanged.