Page1 / 3
 
Statewide Civil, General Equity and Probate Mediation Program

Mediation Case Information Form

Directions: This form is to be completed by the mediator when the mediation is concluded or returned to court.

Question Title

* Case Docket Number (e.g. L-000067-10)

Question Title

* Name of Mediator

Question Title

* Outcome/Nature of Agreement

Question Title

* Number of mediation sessions

Question Title

* Number of hours of preparation time

Question Title

* Number of hours in sessions

Question Title

* Number of hours billed to the parties

Question Title

* At what stage in the case did the mediation sessions take place? (note all that are applicable)

T