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 Report

Civil Action #: County:

Style of Case: vs

The above-styled case was mediated on _________________________ from ____________ until ___________

The mediation resulted in (check one)

_______ FULL SETTLEMENT

_______ PARTIAL SETTLEMENT

_______ IMPASSE

_______ CONTINUATION

The next mediation will be held on __________ (date) at ___________ (time) at _________________(location).

Cancellation

Mediation was cancelled by ________________________________________ on __________________ (date). Comments________________________________________________________________________________

_________________________________________________________________________________________

No Show Parties

Name: _________________________________________________

Name: _________________________________________________

Comments________________________________________________________________________________

_________________________________________________________________________________________

________________________________________ ________________________

Mediator’s Signature Date

Did you get paid in full or work out a suitable payment plan with the parties? Yes No

If no, would you like the ADR office to assist you in collecting these fees? Yes No

Please indicate the amount owed __________ and the party who owes the fees __________________.

Please copy the ADR Office on all invoices sent to this party.

Please fax or mail to the above address

within forty-eight (48) hours of the mediation session.