Your details

Enter the following details to start mediation
TYPE OF MEDIATION
Your details
Your name

First NameLast Name
Your Company's name
If Commercial mediation
Your Email
example@example.com
Your Mobile
Your landline Phone

Area CodePhone Number
Your preferred contact method
Your address

Street Address

Street Address Line 2

SuburbState

Post code
Do you have a legal representative?
Your legal representative details
Your LEGAL FIRM REPRESENTING YOU
Your LAWYER'S NAME
Your Legal representative Email
example@example.com
Your Legal representative landline Phone

Area CodePhone Number
Your Legal representative Mobile
Your Legal representative address

Street Address

Street Address Line 2

SuburbState

Post code
Other party details
Other party name

First NameLast Name
Other party Company's name
If Commercial mediation
Other party Email
example@example.com
Other party Mobile
Other party landline Phone

Area CodePhone Number
Other party preferred contact method
Other party address

Street Address

Street Address Line 2

SuburbState

Post code
Do you know the other party legal representative (if applicable)?
Other party legal representative details
LEGAL FIRM REPRESENTING other party
Other party LAWYER'S NAME
Other party legal representative Email
example@example.com
Other party legal representative landline Phone

Area CodePhone Number
Other party legal representative Mobile
Other party legal representative address

Street Address

Street Address Line 2

SuburbState

Post code
The matter
PROVIDE A BRIEF BACKGROUND OF YOUR MATTER
ADVISE OF ANY MATTERS THAT MAY AFFECT THE CONDUCT OF THE MEDIATION
WHAT OUTCOMES ARE YOU SEEKING
WHAT OUTCOMES ARE YOU SEEKING
WHAT OUTCOMES ARE YOU SEEKING
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Please note that you can upload multiple files. Cancelof
Mediation location
SELECT THE MOST CONVENIENT AREA FOR YOUR MEDIATION:
Brisbane City - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Brisbane inner suburbs - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Brisbane South - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Brisbane West - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Brisbane East - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Gold Coast - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Sunshine Coast - SELECT THE MOST CONVENIENT LOCATION FOR YOUR MEDIATION:
Please provide the city/suburb
Please provide the postcode
ACCEPTANCE OF MEDIATION
I understand that the information provided in this form constitutes my application to start Mediation. By submitting this form, I accept the terms, conditions and costs associated with the mediation process and that the other party will be invited to participate in mediation.

PRIVACY NOTICE:
The information provided by you on this form will:
- be used to evaluate whether your matter is suitable for mediation;
- NOT be provided to any person or third party unless you expressly permit us to do so in writing or as required by law.
(Please refer to the privacy policy for further information).

To accept, please click on the check-box below and insert your name.
I ACCEPT THE ABOVE TERMS AND CONDITIONS
INSERT YOUR NAME
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Enter the following details to start mediation

Your details

Your legal representative details

Other party details

Other party legal representative details

The matter

Mediation location

ACCEPTANCE OF MEDIATION