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  



Phone Number

Court Information

County


          
District Court
Ex. 250th

            County Court at Law #

           
Requested Mediation Date:



Until further notice, all mediations will occur via Zoom Videoconference over the duration of the COVID-19 Pandemic.
Information Regarding the Parties
Petitioner/Plaintiff



Respondent/Defendant




Information Regarding the Child/ren
Name of Child Age
Attorney Requesting Mediation



Address





Phone Number 
Fax Number 


Other Party's Attorney



Address





Phone Number
Fax Number 



Contact Information



Fax Number


Contact Information



Fax Number


 

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.