Mediation intake template

Collect dispute scope, participation status and session preferences before a mediator reviews the matter.

Legal template · 9 fields (6 required) · ~2 min for respondents to complete · Free plan · No credit card · Fully customizable

Set up your mediation intake

Collect dispute scope, participation status and session preferences before a mediator reviews the matter.

Clarify that mediation intake differs from requesting legal representation. The mediator should confirm suitability, participation and process terms separately.

The form separates dispute category, other parties, participation status, related case reference into labeled questions. Review the choices and required fields for your organization before sharing it.

Best practices

• Clarify that mediation intake differs from requesting legal representation. The mediator should confirm suitability, participation and process terms separately.
• Customize the dispute category and other parties questions to match your records and terminology.
• Name the team that reviews responses and explain what happens after submission. A requested date, service or approval is not automatically confirmed.
• Ask only for information needed for this step. Arrange any sensitive supporting documents through an appropriate private process.

Every field, explained

• Your full name (Name, required)
• Email address (Email, required)
• Dispute category (Short text, required)
• Other parties (Short text, required)
• Participation status (Dropdown, required)
• Related case reference (Short text)
• Session preference (Dropdown, required)
• Accessibility or language needs (Long text)
• Goals for discussion (Long text)

Frequently asked questions

What does this mediation intake template collect?

Alongside contact details, it asks for dispute category, other parties, participation status, related case reference, session preference, accessibility or language needs, goals for discussion. You can rename questions, change choices and remove fields that your workflow does not need.

How should I use this mediation intake form?

Clarify that mediation intake differs from requesting legal representation. The mediator should confirm suitability, participation and process terms separately.

Can I edit this form and print a copy?

Yes. Open an editable draft, adjust the questions, and review the preview before publishing. You can also use the template page’s print option. Publishing requires an account; the draft can be tried first.

Related templates

• Legal Consultation Request — 8 fields
• Family Law Intake — 16 fields
• Prospective legal client conflict information — 9 fields

Customize this form — opens an editable draft, no account needed — — or browse all 836 templates.