Book your appointment - Family Matters Mediation

Please note: If you are coming to a face-to-face appointment in our Doncaster office, we are on the fourth floor and the lift is currently out of order. Please let us know if this presents difficulties and we will book a ground floor room.

At the end of this form, you will either be asked to pay a £20.00 deposit if you are applying for legal aid or to pay the full amount for your appointment.

If you are not in a position to pay today, please contact our office on 01302 369688.

Your Case

If we have sent you an email or letter, please add your case number (this will be in the subject line of your email or at the top of your letter).
Case Number
What would you like to talk about?
Reason*
Arrangements for my children
Arrangements for my finances
Arrangements about children and finances
Please tell us more about why you are coming to mediation.
HOW WOULD YOU LIKE YOUR APPOINTMENT TO TAKE PLACE?
Meeting method
Face-to-face
Online video appointment
No preference
At which location?*
We can routinely offer face to face appointments in our main office in Doncaster, Newark and Lincoln. If you need a face to face appointment in another location we will try to arrange this.
Doncaster
Newark
Lincoln
ABOUT YOU
First Name*
Surname*
Address Line 1*
Address Line 2
City / Town*
County*
Post Code*
Contact Number*
Email*

Date of Birth*
What is your National Insurance number?
Occupation*
Ethnic origin :*
Preferred contact method:*
Phone
Email
Text
Would you like us to call you to talk about your case?
Yes
No
What time should we call?
Before 9am
Between 9am & 3pm
Between 3pm & 7pm
Will you need support coming to or taking part in your mediation?
No
Yes
What is the name of the person you would like to support you?*
Please give details of the support required:
When is the best time to make your appointment?
All appointment will take between 45-60 minutes. Make sure you will have time to take part.
We will try to book your appointment to fit in with you. If you give us as much availability as possible we will have the best chance of offering you an appointment you can come to.
Can you be available at late notice if we have a cancellation?
Yes
No
Do you need notice?
No
Yes, 3-5 days
Yes, 5-7 Days
Morning Appointments
Start time between 9am and 1pm
Chose the dates you can take part in an appointment
Afternoon Appointments
Start time between 1pm and 2.30pm
Chose the dates you can take part in an appointment
Late Afternoon Appointments
Start time between 2.30pm and 5pm
Chose the dates you can take part in an appointment
The best way to help us offer you an appointment which will work is for you to tick at least six dates when you can be available.
Confidentiality
Does the other person in your case know your email address?
Yes
No
Can your email be shared with the other person in your case?
Yes
No
Your Safety
Have the police ever been called by you or the other person in your case?*
No
Yes
Has any action been taken by the police or courts against you or the other person in your case?*
No
Yes
Are there any court orders in place which relate to you or the other person? This means bail conditions / a harassment order or an injunction*
No
Yes
Is there a harassment order in place?
No
Yes
Is there a non-molestation Order in place?
No
Yes
Any other information you would like to provide?
Your children’s safety
Have the children’s services or social workers been in contact with you or the other person about the children?*
No
Yes
Terms & Conditions
Do you consent to us sending you updates about developments in mediation and quarterly newsletters?
Yes
No
Family Matters work with mediators who are working to a higher level or qualification, this means two mediators will be working on your case. Do you agree that this can take place ?*
Yes
No
I have read and accept Family Matters Payments and Refunds policy and privacy policy*
Yes
Read our privacy policy here
Read our payments and refunds policy here
Payment and Legal Aid funding
Do you want to apply for legal aid funding?
*Qualifying benefits for legal aid: Universal Credit, Income-related Employment and Support Allowance, Income-based Jobseeker’s Allowance, Income Support, Pension Guarantee Credit.
Are you working?
No
Yes
Please upload a photo or scan of your wage slip for the last month:

Drop files here or

Do you have a partner?
No
Yes
Are they working?
No
Yes
Please upload a photo or scan of your partners wage slip for the last month:

Drop files here or

Do you have a house which is in your name or your name with another person?
No
Yes
What is the value of the house?:
What is the mortgage?:
Please upload a bank statement showing your mortgage payment

Drop files here or

What is the total balance of your bank accounts (and your partner’s, if you have one)?
Are you getting benefits (including Universal Credit)?
No
Yes
Please upload your JSA / ESA letter / A screen shot of your most recent UC payment:
(It must clearly show your name, address and the date you have been paid)

Drop files here or

Where are you living?
My own property
Renting
With friends and family
Please upload a photo or scan of your rental agreement

Drop files here or

Number of places
Cost per place
Subtotal
Price: £ 0.00 Quantity:
Total amount (inc. VAT)
£ 0.00
Name
This field is for validation purposes and should be left unchanged.