Solicitor Referral Form

If you are a solicitor and wish to refer a client to Hethertons Mediation, please fill in the Solicitor Referral form below. Once received, we will acknowledge your referral in writing and then contact your client directly to arrange a mutually convenient appointment for them to attend for their Mediation Information Assessment Meeting (MIAM).

If you require any further information, please feel free to contact us by email at enquiries@hethertonsmediation.co.uk, by phone on 01904 528200, or by fax on 01904 791506.

Solicitor Referral Form

* required fields

Party 1

Details








Solicitor Details (if applicable)








Party 2

Details








Solicitor Details (if applicable)








Details of any children

Child to both of parties YesNo
Child to both of parties YesNo
Child to both of parties YesNo
Child to both of parties YesNo
Child to both of partiesYesNo
Child to both of parties YesNo

Mediation Details

SeparationMatrimonial FinancesCo-habitation FinancesChildren- living arrangementsChildren- contactParental ResponsibilityOther

If other please specify


YesNo


YesNo