Intake form

Help us serve you better

Name *

Email address *

What type of dispute are you experiencing?

Please select at least one option.

Business dispute

Personal dispute

Family dispute

Contractual issue

Employment issue

What is your preferred method of communication?

Please describe the nature of your dispute.

How long have you been experiencing this dispute?

What are your desired outcomes from mediation?

Have you previously attempted to resolve this dispute?

If yes, please describe the previous attempts made.

Would you like to include any additional parties in the mediation?

Please select at least one option.

Business partners

Family members

Legal representatives

What is your preferred date and time for the mediation session?

Additional questions or comments

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Harmony Resolution Services