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Client Inquiry Form

Client Intake Form

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Client Intake Form

Client Intake Form

This general intake form will help our staff assess the nature of your dispute and develop a proper resolution strategy. Please complete this form to the best of your ability.

For more information on how you or you client may qualify for pro bono mediation services, click here:

Your Name *

Your Phone Number *

Your Email *

What is the name of party looking for dispute resolution services (if different than above)?

What is your relationship to the party seeking dispute resolution services? *

What is the name of the individual/organization with whom you currently have conflict? *

Nature of the Dispute *

Is this matter currently in litigation? *

Yes
No

If this matter is currently in litigation, are you the:

Plaintiff
Defendant
This matter is not in litigation

If this matter is currently in litigation, please check all that apply:

Pleadings have been filed.
Notice has been served to the defendant.
Discovery has commenced.
Parties have participated in mediation.
Trial has been scheduled.
Settlement conference has been conducted.
Trial has commenced.
This matter is not in litigation.

Acknowledgement *

By submitting this form, I acknowledge the following: George Milton Group is not a law firm; Mediation is a voluntary dispute resolution process; The information submitted above is true and accurate; Submission of this form does not create a relationship between you and the George Milton Group.

Name

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