Relating to Children yes no

Property & Finance yes no

Both yes no

Have you made any allegations of domestic violence against the other? yes no

Do you or other party have any special needs? yes no

Will you or other party require an interpreter? yes no *

 *If yes, language?

Do you or other party require disabled access? yes no

Do you think you or the other person might be eligible for legal aid? yes no

Is the other party aware of the referral to mediation? yes no

Do you wish us to contact them at this stage? yes no

Where would you prefer to meet with us? Coalville Hinckley Leicester Loughborough Market Harborough Melton Oakham

For security purposes please answer this simple question:
What is 2 + 2?