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* 3. Do you have an attorney?

* 4. Please rate each answer to the following questions on a scale of 1 (Not at all) to 5 (Completely).

  1 - Not at all 2 3 4 5 - Completely
I was able to freely ask questions and say what I needed to say during the mediation
My attorney prepared me for mediation.
Having the mediator present was helpful.
The mediator explained the mediation process.
The mediator allowed both sides to express their views.
I felt pressured by the mediator to go along with things I did not want.
The mediator recommended a specific decision.
I have a better understanding of the situation.
I have a better understanding of the other party's perspective.
I believe that the other party has a better understanding of my perspective.
I experienced fear or intimidation during the mediation because of the other party.
My experience in mediation helped me to decide the next steps to effectively deal with the situation.
The mediation fee was reasonable.
I was satisfied with the mediation process.
I was satisfied with the mediator.
Overall, the mediation was useful to me.
I would recommend mediation to another person in a similar situation.
I would choose mediation again if I have another conflict.

* 5. If there were any drawbacks to your mediation experience, please explain:

* 6. If there were any benefits to your mediation experience, please explain:

* 7. What would help us improve the mediation experience for other people?

* 8. During the mediation...

* 10. Date of Mediation


* 12. Case Number

* 13. Can we share your responses with your mediator?

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