Inclusion in Mediation Survey Form
Please complete this survey to help us assess whether you or your matter are suitable for mediation. All questions are designed to support an inclusive, respectful process. Your responses will remain confidential and are used solely for mediation assessment purposes.
Your role in the mediation process
*
Please Select
Party to the dispute
Legal representative
Support person
Mediator
Other
How would you rate your understanding of the mediation process?
*
1
2
3
4
5
Have you participated in mediation before?
*
Yes
No
How open are you to resolving this matter through mediation?
*
Not open at all
1
2
3
4
Very open
5
1 is Not open at all, 5 is Very open
Please indicate your level of agreement with the following statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
All parties have equal opportunity to participate.
1
2
3
4
5
I feel comfortable expressing my views in mediation.
6
7
8
9
10
I believe mediation can lead to a fair outcome.
11
12
13
14
15
Are there any barriers that might prevent full participation in mediation?
Language barriers
Accessibility needs
Scheduling constraints
Cultural considerations
None
Other
What is your preferred communication method for mediation?
*
In-person
Video conference
Phone call
Written/email
Other
What do you hope to achieve through mediation?
Do you have any additional comments or considerations?
If you wish to be contacted about this survey, please provide your email address.
example@example.com
Submit Survey
Should be Empty: