Contact / Referral - PEAK MEDIATION

Contact Us

Email: [email protected]
Telephone: 07368526803
Administration address: 94 Smedley Street, Matlock, Derbyshire, DE4 3JJ

To make a referral please complete the form below.

Please be aware we are unable to offer Legal Aid for our Mediation services, if you are seeking this please visit www.focusfamilymediation.co.uk and confirm that you have received their details from Peak Mediation. If you are seeking Legal Aid Mediation please contact [email protected]

Referral Form for Peak Mediation - Please fill in all boxes before sending

* Indicates required field

Participant 1 *

First

Last

Participant 2 *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Phone Number *

Email *

Email *

Solicitors *

Solicitors *

Relationship between participants *

Date of Relationship / Marriage *

Date of Separation *

Children Name (s), Date of Birth *

Dispute / Reason for Mediation (Children / Property and Finance / Both Children and Property and Finance / Separation) *

Brief Description of issues *

Submit