Mediation Request Form - New

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Case Information

In the Matter of the Marriage of (and/or) In the Interest of:
i.e. Smith/Jones
Name of Person Submitting This Form:




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Court Information

County


District Court
Ex. 250th

County Court at Law #

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Information Regarding the Parties
Petitioner



Respondent




Information Regarding the Child/ren

Name of Child Age
Attorney Requesting Mediation



Address






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Other Party's Attorney



Address






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Contact Information




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Contact Information




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This form is to submit a request for mediation on a specific date.  The mediation is not confirmed until the parties have received written confirmation from Mark W. Sims, Attorney-Mediator, that the mediation has been scheduled on the requested date.  

If the mediation cannot be scheduled with Mark W. Sims for whatever reason, you will be notified as quickly as possible but no later than the next day after submitting the form.    

Once the mediation is scheduled, confirmations will be sent out to the parties via the contact information submitted with this form. 

If you do not receive any communication from Mark W. Sims by the next business day after requesting a mediation date or completing this form, please contact Mark W. Sims at texaslaw@austinmediation.com. 

By submitting this form, you agree to the cancellation policy (which applies to short notice cancellations) specifically outlined at Mr. Sims' website, www.austinmediation.com.