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Refer a Case

Referring a case to ADR Group for mediation is very straightforward. Simply complete the online form below or download a PDF version and send to us by post or fax.

You can be assured that all cases are treated with the utmost confidentiality right from the start.

Having received your completed form, ADRg’s Case Management Team will endeavour to contact you as quickly as possible to discuss the next steps in the process and obtain all other relevant details.

Who is filling in this form? Claimant:
Defendant :

Claimant:

Defendant:

Full Name / Company Name:

Full Name / Company Name:

Claimant Address:

Defendant Address:

Phone Number:

Phone Number:


Nature of claim and brief description:

Approximate amount of dispute:

Complexity (low / medium / high):


Claimant's Solicitor / Advisor:

Defendant's Solicitor / Advisor:

First Name:

First Name:

Firm:

Firm:

Address:

Address:

DX:

DX:

Phone Number:

Phone Number:

Fax Number:

Fax Number:

Email:

Email:

Ref:

Ref:

Has mediation been discussed with the other party(ies)?
 Yes:
No:
If yes, have all party(ies) agreed to mediation Yes:
No:

If the mediation has not been proposed with the other party(ies), is ADR Group to approach them?

Yes:
No:

Please indicate preferred time scale for the mediation


Please indicate preferred location for the mediation
 
Ideally, would you like us to provide mediators from the above location? Yes:
No:

Is this a court referred mediation?

Yes:
No:

Are the fees to be split equally between the parties. 

Yes:
No:

Will the parties professional advisor(s) if any be in attendance at the mediation along with the parties?

Yes:
No:

Are there any other issues you or your client consider important and which may be relevant to in the choice of mediator?

Yes:
No:

How did you hear about ADR Group?

 
 
 


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