Office of Dispute Resolution

SEVENTH JUDICIAL ADMINISTRATIVE DISTRICT

P.O. BOX 963 PHONE: (770) 387-4820

CARTERSVILLE, GA 30120 TOLL FREE: (877) 655-6865

www.7jad.com FAX: (770) 387-5479

PDF VERSION

Mediation Participant Survey Form

Civil Action #: County:

Style of Case: vs

1. The mediator fully explained the mediation process to me:

Yes No

2. The mediator listened to my concerns:

Most of the time Some of the time Not at all

3. The mediator treated both sides equally:

Most of the time Some of the time Not at all

4. The mediator assisted us in coming up with ways to resolve our disagreement(s):

Most of the time Some of the time Not at all

5. Did you reach an agreement?

Yes No

6. If you reached an agreement, do you think the agreement will resolve the problem?

Yes No Do not know

7. If you reached an agreement, how likely is it that the decisions made will actually work?

Very likely Somewhat likely Not likely

8. If you reached an agreement, do you think the agreement was fair to both parties?

Yes No

9. How helpful was the 7^th District’s ADR Office to you?

Very helpful Helpful Not helpful Had no contact

10. Overall, I was satisfied with the mediation process.

Yes No

11. Please tell us what we can do to improve the mediation process:

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Please mail or fax to the address above