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Refer a workplace mediation Case to ADRG online

Refer a Case

Please use the form below to refer a Workplace case to us :

* indicates required

Who is filling in this form?*
Claimant Defendant

Claimant Details

Full Name / Company Name

Claimant Address

Phone Number

Defendant Details

Full Name / Company Name

Defendant Address

Phone Number

General Claim Details

Nature of claim and brief description

Approximate amount of dispute

Complexity

Claimant's Solicitor / Advisor

First Name

Firm

Address

DX

Phone Number

Fax Number

Email

Ref

Defendant's Solicitor / Advisor

First Name

Firm

Address

DX

Phone Number

Fax Number

Email

Ref

Other Details

Has mediation been discussed with the other party(ies)?
Yes No

If yes, have all party(ies) agreed to mediation
Yes No

If the mediation has not been proposed with the other party(ies), is ADR Group to approach them?
Yes No

Please indicate preferred time scale for the mediation

Please indicate preferred location for the mediation

Ideally, would you like us to provide mediators from the above location?
Yes No

Is this a court referred mediation?
Yes No

Are the fees to be split equally between the parties
Yes No

Will the parties professional advisor(s) if any be in attendance at the mediation along with the parties?
Yes No

Are there any other issues you or your client consider important and which may be relevant to in the choice of mediator?
Yes No

How did you hear about ADR Group?

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