• Referral Form

    Referral Form

  • Getting Started

  • Thank you for choosing Pax Mediation.

    Please complete this short referral form so we can gather the information we need to arrange your Mediation Information and Assessment Meeting (MIAM).

    We’ll ask you for some basic contact details and a little information about your situation. This helps your mediator prepare for your meeting and make sure we can support you appropriately.

    If you have any difficulty completing the form, or need it in another format, please contact us and we’ll be happy to help.

    What happens next?

    1. You complete the form
    This should only take a few minutes.

    2. We review your information
    Our team will check your details and get in touch.

    3. We arrange your MIAM
    We’ll contact you to arrange the next steps.

     

  • Your Information and Privacy

  • We take your privacy seriously and will use the information you provide to deal with your referral and provide our mediation services. You can read more about how we collect, store and use your personal information in our Privacy Notice.

  • Your Contact Details

  • Your Date of Birth*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Format: 00000 000 000.
  • Have you instructed a solicitor?

  • Other Parties Contact Details

  • Their Date of Birth
     / /
    2 digit day, 2 digit month, 4 digit year
  • Format: 00000 000 000.
  • Have they instructed a solicitor?

  • Issue(s) for Mediation

  • What are the issues for mediation?
  • Child(ren)’s details
    Rows

  • Standard Questions

  • Does the other party know about the referral?
  • Do you feel able to ask the other party to get in touch with us?
  • Do you want to request a joint MIAM?

  • Funding

  • Our mediation service is amongst the most cost-effective options available. You can find details about our charges here: https://www.paxmediation.co.uk/mediation-fees

    If you proceed on a privately paying basis, we will send potential dates for an appointment upon receiving your referral.

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    We are also one of the few providers in the UK contracted to provide mediation funded by Legal Aid. If you are eligible, mediation is FREE for you. The Legal Aid assessment for Family Mediation is means-based, and you can find more information here: https://www.gov.uk/legal-aid

    If you proceed on a legally aided basis, we will send instructions on applying for legal aid upon receiving your referral. We will assess your eligibility ahead of your appointment and if you are not eligible you do not have to proceed.

  • How would you like to proceed?*

  • Your Availability

  • Private Clients

  • Thank you for confirming that you will pay for the meeting. The next step is to arrange your Mediation Information and Assessment Meeting (MIAM).

    So that we can offer an appointment as soon as possible that suits your needs please indicate your preference for timing and venue. Select as many dates, times and venues that are possible for you. Once you have completed the form, we will then send specific dates and times in line with your preference.

    Our charges are listed below:

    Online (Zoom) £140
    Face-to-Face / In person £150
    Out of Hours (Zoom) £200

    Please note, we currently have greater availability for Online (ZOOM) appointments and we may be able to offer an appointment sooner if you attend this way.

  • Date and Timing Preference (select any that are suitable for you)*
    Rows
  • Venue Preference (select any that are suitable for you)*
  • Face-to-Face / In person Venue Preference (select any that are suitable for you)*

  • Conclusion

  • Now, please press submit to complete the referral form.

    • If you have told us that you will pay for your meeting, we will contact you by email shortly to provide potential dates for your appointment in line with your preferences.
    • If you have told us that you wish to apply for Legal Aid, we will re-direct you to the Legal Aid application form, and we will also send a copy of this to the email address that you provided. 

    Do check your junk and spam folders for our emails. If you are unable to correspond by email please contact us on 0800 058 4303.

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