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Refer a Case

Please complete the form below to refer a case to us (* required fields).

Claimant Details
Who is filling in this form? *	Claimant Defendant
Full Name / Company Name
Claimant Address
Phone Number
Defendant Details
Full Name / Company Name
Defendant Address
Phone Number
General Claim Details
Nature of claim and brief description
Approximate amount of dispute
Complexity
Claimant's Solicitor / Advisor
Name
Firm
Address
DX
Phone Number
Fax Number
Email
Ref
Defendant's Solicitor / Advisor
Name
Firm
Address
DX
Phone Number
Fax Number
Email
Ref
Other Details
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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