There are only a few occasions in the lifetime of a business, where the opportunity fills you with both excitement and caution in equal measure.

These are the times when only enthusiastic expertise will Dootsons

Client 1 (Applicant)

Client 2 (Respondent)

Is a willingness test required?

Are there domestic abuse issues that might prevent mediation taking place?

If Yes give details below





Is your client exempt as LSC eligible?

Private Client Referrals Only Accepted

Is this referral being made under the Pre-Application Protocol?

Home Tel:

Mobile Tel:


Any client requirements

Please give details

e.g lifts, interpreter etc

Legal Status: Married / Cohabiting / wider family members / etc

Type of Case: Children's Issues / Finance and property Issues / All Issues

Child(ren) names



Living with ?

Any Social Services involvement

Any Court proceedings

Is the other party aware of the referral

Please provide any further information below

Please complete all questions and  click on the submit button at the bottom of the form. If you are requesting a willingness test you must provide a current telephone number and full postal address for both clients. Failure to do so may delay the mediation process.

Mediation Referral Form