NOCO Mediation Intake Form
Please select dates that are currently available. Click here to review Erin Redmond Claeys calendar.
Date
Case Number
Requesting Party's First Name
Requesting Party's Last Name
Requesting Party's Email
Requesting Party's Phone
Requesting Party's Prior Names
Requesting Party's Attorney Name and Email Address
Other Party's First Name
Other Party's Last Name
Other Party's Email
Other Party's Phone
Prior Names of Other Party
Other Party's Attorney Name and Phone Number
Add any other relevant emails
List any past or current affiliation with Erin Redmond Claeys or the NOCO Mediation Center
What issues are you looking to Mediate?
Desired Mediation Date
Desired Mediation Time
Desired Second Mediation Date
Desired Second Mediation Time
Desired Third Mediation Date
Desired Third Mediation Time
Have these dates been pre-cleared with the Opposing Party
Yes
No
Have you reviewed Miss Claeys calendar to find out if these dates are available?
Yes
No
Preffered Mediation Location
Virtual
In-person
Physical Limitations of Either Party
Please add any general notes or comments below if necessary
Submit form