Office of Dispute
Resolution
SEVENTH
JUDICIAL ADMINISTRATIVE DISTRICT
P.O.
www.7jad.com FAX: (770) 387-5479
Civil and
Domestic Mediation Scheduling Form
STEP ONE
Civil
Action #: County:
Style
of Case: vs
Name
of Mediator: Location of Mediation:
Date
of Mediation: Time
of Mediation:
STEP TWO
PLAINTIFF’S DATA DEFENDANT’S DATA
Name: (Last, First MI) Name:
(Last, First MI)
Mail Address Mail
Address
City,
State and Zip City,
State and Zip
Phone Phone
Attorney’s Name Attorney’s
Name
City, State and Zip City,
State and Zip
Phone / Fax Phone / Fax
STEP THREE
No unilateral scheduling is
permitted. By signing below, I am stating that the choice of mediator, date, time,
and location listed above is the result of a mutual decision made between
Plainiff(s). Defendant(s), and Mediator.
Print Name: (Last, First MI) Attorney
Office
Signature Required / Date Phone
Please
give a brief description of any special circumstances.
It is essential that copies of all documents bearing on issues to
be resolved be brought to the mediation session (financial, medical, business,
etc.)
STEP FOUR
Domestic Relations Only (please circle appropriate response)
Divorce:
Alimony /
Child support / Custody
/ Debt Division /
Property Division
Modification: Alimony /
Child Support / Custody
/ Visitation
Are there concerns of abuse (spouse, child, substance, etc) that are alleged or otherwise indicated? Y / N