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 or emailed to DParks7881@aol.com.

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) Family Cases Only

**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 of the 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.