The Mediation Centre
7/8 St.Mary's Grove, Stafford, ST16 2AT

Mediation phoneline :
01785 273133

e-mail us at : tmc@nowellmeller.co.uk

Public Funding (free Legal Aid) may be available¹

Search The Mediation Centre

Solicitor's referral form

Untitled Document

Your client's information

Name :		*
Date of birth :		*
Address :		*



Postcode		*
Home telephone number:
Work telephone number:
Mobile telephone number:

* indicates mandatory information

Partner's information

(Any contact information you may have is extremely useful)

Name :		*
Date of birth :
Address :		*



Postcode
Home telephone number:
Work telephone number:
Mobile telephone number:

* indicates mandatory information

Your firm's information

Name :		*
DX :
Telephone number :		*
Reference		*

1. Does your client's ex-partner have a solicitor?

Yes No I don't know
If yes please provide the solicitor's details here

2. Is this a referral to family mediation

under the Funding Code (Formerly s.29 of the FLA 1996) a voluntary referral on behalf of both parties

3. Is your client likely to want a joint or separate assessment meeting?

Separate Joint

4. Has your client's ex-partner agreed to the referral?

Yes No

5. Which office would your client like to meet at?

The Dudson Centre, Hope Street, Hanley Our Stafford Office

6. What are the likely issues?

Children Finance & Property Other

7. Does the partner know about the impending divorce/separation?

Yes No

8. Would your client prefer us to write or telephone their ex-partner?

Write Telephone

9. Is there anything else you would like to tell us that you think might be helpful?

Nowell Meller Solicitors are Investors in People