Mediation Intake Form

Mediation Intake Form for Canada

Mediation Intake Form Template for Canada

A comprehensive intake form used in Canadian mediation proceedings to gather essential information from parties seeking to engage in mediation services. This document complies with federal and provincial mediation regulations and privacy laws, collecting necessary details about the parties, nature of the dispute, scheduling preferences, and special requirements. The form serves as the initial step in the mediation process, helping mediators assess the case, identify potential issues, and prepare for effective dispute resolution while ensuring all necessary legal and procedural requirements are met.

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What is a Mediation Intake Form?

The Mediation Intake Form is a foundational document used across Canadian jurisdictions to initiate the mediation process. It serves as the primary information-gathering tool for mediators and mediation service providers, ensuring all relevant details about the dispute and parties are properly documented. The form is designed to comply with Canadian federal and provincial privacy legislation, including PIPEDA where applicable, and aligns with professional mediation standards. It captures crucial information such as party details, dispute nature, scheduling preferences, and special requirements, while maintaining confidentiality and professional standards. This document is typically used before commencing mediation sessions and helps determine the appropriate approach to dispute resolution while ensuring all necessary legal and procedural requirements are satisfied.

What sections should be included in a Mediation Intake Form?

1. Personal Information: Basic contact details, preferred contact methods, and identification information for the party completing the form

2. Other Party Information: Contact information for other parties involved in the dispute, if known

3. Legal Representation: Details of any legal counsel or representatives, including contact information

4. Nature of Dispute: Brief description of the dispute, including key issues, timeline, and desired outcomes

5. Previous Resolution Attempts: Information about any previous attempts to resolve the dispute, including other mediations or legal proceedings

6. Time and Scheduling Preferences: Preferred dates, times, and any scheduling constraints for the mediation

7. Special Requirements: Any accessibility needs, language requirements, or other special accommodations needed

8. Confidentiality Agreement: Standard confidentiality terms and acknowledgment

9. Fees and Payment Information: Understanding of fee structure and payment arrangements

10. Acknowledgment and Signature: Confirmation of accuracy of information and agreement to proceed with mediation

What sections are optional to include in a Mediation Intake Form?

1. Cultural Considerations: Section for identifying any cultural factors that may affect the mediation process

2. Power Imbalance Assessment: For family or workplace disputes where power dynamics need to be assessed

3. Safety Concerns: For cases involving potential safety issues or history of violence

4. Multi-Party Details: Additional section for disputes involving multiple parties

5. Insurance Information: For disputes involving insurance claims or coverage

6. Court-Connected Information: For mediations connected to ongoing court proceedings

7. Document Inventory: List of relevant documents party intends to bring to mediation

What schedules should be included in a Mediation Intake Form?

1. Schedule A - Fee Schedule: Detailed breakdown of mediation fees, cancellation policies, and payment terms

2. Schedule B - Mediator Code of Conduct: Standard mediator code of conduct and ethical guidelines

3. Schedule C - Privacy Policy: Detailed privacy policy and information handling procedures

4. Appendix 1 - Mediation Process Guide: Information sheet explaining the mediation process

5. Appendix 2 - Required Documents Checklist: List of documents parties should prepare for the mediation

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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What is a Mediation Intake Form?

What sections should be included in a Mediation Intake Form?

What sections are optional to include in a Mediation Intake Form?

What schedules should be included in a Mediation Intake Form?

Authors

Alex Denne

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