DP Mediation Services, LLC
DP Mediation Services, LLC

Forms Needed for Virtual/Telephonic Mediation Sessions

Please download, complete and return the attached documents prior to scheduled session.  These documents may be scanned, faxed (757) 242-6723, email or you may take clear picture and text them back to me.

 

General Cases (General District Court) (each participant completes the followiing forms)

 

1.  General Questionnaire – complete, sign and return prior to mediation

2.  Agreement to mediate- sign and return prior to mediation (petitioner is the person who filed)

3.  Evaluation – complete and return after the session (usually 1 session, 1 hour at question #3).

 

Family Cases (Juvenile & Domestic Relations District Court )(each participant complete the following forms)

 

1.  Family Questionnaire – complete, sign and return prior to mediation

2.  Agreement to mediate- sign and return prior to mediation (petitioner is the person who filed)

3.  Domestic Violence Screening – required by statute (yes or no answers are acceptable)

4.  Evaluation – complete and return after the session (usually 1 session, 1 hour at question #3)

 

 

DCSE Consent (use only of you are participating in DCSE Survey)

 

**DCSE Consent Forms fill out only one of the forms.  One form is for if Department of Child Support Services is involved with your Child Support Case, Non –DCSE for Child Support Cases not involving Department of Child Support Enforce.  I will explain the survey prior to our session.

 

*If we make an agreement in mediation, it will be emailed to all parties.  One parties need to download a hard copy that must be signed by all parties and mailed back to me at P.O. Box 558 Windsor, Virginia 23487 along with the documents above if they have not already been sent back to me.

If you have further questions, I may be contacted directly at (757) 818-8669.  

 

 

General Questionnaire
DPMSGeneral Intake 1.docx
Microsoft Word document [16.5 KB]
Agreement to Mediate
Agreement to Mediate - Virtual.doc
Microsoft Word document [38.5 KB]
Family Questionnaire
DPMS FAMILY QUESTIONNAIRE 1.doc
Microsoft Word document [39.0 KB]
Domestic Screening
DPMS Screening.doc
Microsoft Word document [41.5 KB]
Client Evaluation
DPMS Client Evaluation.doc
Microsoft Word document [35.0 KB]
DCSE Consent Form
DCSE consent form - final.doc
Microsoft Word document [43.0 KB]
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