MEDIATION IN-TAKE SHEET

FLORIDA COURT RESOLUTION CENTER


STYLE OF CASE: _______________________VS. ________________________


PLAINTIFF/PETITIONER

Name:            ___________________________________________________________________________________________________________

Attorney:       ___________________________________________________________________________________________________________

Address:        ___________________________________________________________________________________________________________

Telephone     ___________________________________________________________________________________________________________

Fax/e-mail     ___________________________________________________________________________________________________________



DEFENDANT/RESPONDENT

Name:           ___________________________________________________________________________________________________________

Attorney:       ___________________________________________________________________________________________________________

Address:        ___________________________________________________________________________________________________________

Telephone:    ___________________________________________________________________________________________________________

Fax/e-mail     ___________________________________________________________________________________________________________

 

NATURE OF DISPUTE:_________________________________________________________________________________________________

                      ___________________________________________________________________________________________________________

                      ___________________________________________________________________________________________________________

                          ___________________________________________________________________________________________________________  

Preferred Dates (Give at least three (3) dates for mediation)

_______________________________________________________________________

_______________________________________________________________________


SCHEDULING MEDIATION WITH FLORIDA COURT RESOLUTION CENTER

BY TELEPHONE * Call (407) 870-8857
BY FAX * Complete In-Take Sheet and Fax to (407) 932-4750

BY MAIL * Complete In-Take Sheet and mail to: Florida Court Resolution Center, 24 North Clyde Avenue, Kissimmee, Florida 34741

E-Mail * Cut and paste Complete In-Take Sheet & send to jp@courtresolution.com

©2009 Florida Court Mediation Inc. 


www.courtresolution.com