Mediation Intake Form

Mediation Intake Form Template for Canada

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Key Requirements PROMPT example:

"I need a Mediation Intake Form for a complex commercial construction dispute involving four parties, with sections for document inventory and insurance information, compliant with Ontario regulations and scheduled to begin mediation in March 2025."

Document background

The Mediation Intake Form is a foundational document used across Canadian jurisdictions to initiate the mediation process. It serves as the primary information-gathering tool for mediators and mediation service providers, ensuring all relevant details about the dispute and parties are properly documented. The form is designed to comply with Canadian federal and provincial privacy legislation, including PIPEDA where applicable, and aligns with professional mediation standards. It captures crucial information such as party details, dispute nature, scheduling preferences, and special requirements, while maintaining confidentiality and professional standards. This document is typically used before commencing mediation sessions and helps determine the appropriate approach to dispute resolution while ensuring all necessary legal and procedural requirements are satisfied.

Suggested Sections

1. Personal Information: Basic contact details, preferred contact methods, and identification information for the party completing the form

2. Other Party Information: Contact information for other parties involved in the dispute, if known

3. Legal Representation: Details of any legal counsel or representatives, including contact information

4. Nature of Dispute: Brief description of the dispute, including key issues, timeline, and desired outcomes

5. Previous Resolution Attempts: Information about any previous attempts to resolve the dispute, including other mediations or legal proceedings

6. Time and Scheduling Preferences: Preferred dates, times, and any scheduling constraints for the mediation

7. Special Requirements: Any accessibility needs, language requirements, or other special accommodations needed

8. Confidentiality Agreement: Standard confidentiality terms and acknowledgment

9. Fees and Payment Information: Understanding of fee structure and payment arrangements

10. Acknowledgment and Signature: Confirmation of accuracy of information and agreement to proceed with mediation

Optional Sections

1. Cultural Considerations: Section for identifying any cultural factors that may affect the mediation process

2. Power Imbalance Assessment: For family or workplace disputes where power dynamics need to be assessed

3. Safety Concerns: For cases involving potential safety issues or history of violence

4. Multi-Party Details: Additional section for disputes involving multiple parties

5. Insurance Information: For disputes involving insurance claims or coverage

6. Court-Connected Information: For mediations connected to ongoing court proceedings

7. Document Inventory: List of relevant documents party intends to bring to mediation

Suggested Schedules

1. Schedule A - Fee Schedule: Detailed breakdown of mediation fees, cancellation policies, and payment terms

2. Schedule B - Mediator Code of Conduct: Standard mediator code of conduct and ethical guidelines

3. Schedule C - Privacy Policy: Detailed privacy policy and information handling procedures

4. Appendix 1 - Mediation Process Guide: Information sheet explaining the mediation process

5. Appendix 2 - Required Documents Checklist: List of documents parties should prepare for the mediation

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Legal Services

Healthcare

Real Estate

Construction

Financial Services

Insurance

Manufacturing

Retail

Education

Professional Services

Employment Services

Family Services

Government and Public Sector

Non-profit Organizations

Relevant Teams

Legal

Human Resources

Compliance

Risk Management

Client Services

Administrative Services

Dispute Resolution

Corporate Affairs

Employee Relations

Relevant Roles

Mediator

Alternative Dispute Resolution Specialist

Legal Counsel

Paralegal

Court Administrator

Human Resources Manager

Employee Relations Manager

Risk Manager

Compliance Officer

Case Manager

Client Services Coordinator

Practice Manager

Legal Administrator

Dispute Resolution Officer

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