Community Mediation - Intake Form | The Neighbourhood Group

The first step is to add some some basic information in the form below about your conflict. All information you provide is confidential and will not be shared with the person or people with whom you are in conflict. If you decide to try mediation, we will contact the people you are in conflict with to see if they are willing to join the mediation.

CONTACT INFORMATION:
Full Name:
Address:
Phone Number:
Email:
Preferred method for contact:	Select one Phone Email
Preferred Method for Meeting:	Select one Online In-Person
CONTACT INFORMATION - OTHER PERSON:
Nature of the Conflict:	Please briefly describe the conflict (500 characters maximum)
Nature of the Conflict (if needed):	Add additional information in this box about the conflict if you need extra space
Nature of the Conflict (if needed):	Add additional information in this box about the conflict if you need extra space
OTHER INFORMATION ABOUT YOU:
Age:
Ethnicity:
Gender:
Preferred Language:
How Did You Hear About Us?:
reCAPTCHA: