Rate Your Experience
We value your feedback, please complete the form below.
Name
First Name
Last Name
Mediation West Case Number
*
Mediator(s) Name(s)
How well did the mediator(s) explain to you what mediation would involve?
Very Well
Well
Okay
Not Well
Not At All
How fair was the mediation process?
Very Fair
Fair
Average
Unfair
Very Unfair
During the mediation session, to what degree did you have the opportunity to fully express your views?
Very High
High
Average
Low
Very Low
How well were the issues important to you identified and discussed in the mediation session?
Very Well
Well
Okay
Poorly
Very Poorly
We reached an agreement through mediation covering ________ of the issues important to me.
All
Most
Some
A Few
None
To what degree did the mediator(s) understand you?
Very Well
Well
Average
Not Well
Not at All
How neutral would you rate the mediator(s) to be?
Completely Neutral
Mostly Neutral
Somewhat Neutral
A Little Neutral
Not at All Neutral
To what degree did you feel you were treated with respect by the mediator(s)?
Very High
High
Average
Low
Very Low
To what degree did you feel pressured by the mediator(s) to resolve the dispute quickly?
Not at All
Slightly
Somewhat
Moderately
Highly
How would you rate your level of satisfaction with outcome of the mediation session(s)
Very High
High
Average
Low
Very Low
How would you rate your level of satisfaction with the mediation process?
Very High
High
Average
Low
Very Low
What would you tell a friend who asks you. "Do you think I should try mediation?"
Are you comfortable being contacted about your feedback?
Yes
No
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