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* 2. Date of Mediation

Date

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* 3. Case Number

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* 4. Please choose the option that describes your role in this case

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* 5. Did you receive written information about mediation before you went to your first mediation session?

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* 6. Did the information help to make you feel comfortable about trying the mediation process?

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* 7. Please rate your satisfaction in each of the following situations

  Very Satisfied Satisfied Neither Satisfied or Dissatisfied Dissatisfied Very Dissatisfied No answer
The explanation the mediator gave during the introduction about how mediation works.
The opportunity to have a part in deciding the outcome of the dispute.
The ability of the mediator to remain neutral.
The opportunity you had to present your side.
The opportunity you had to talk through solutions.
The fairness of the process.
The overall outcome.
The mediation process as a method of resolving future conflicts.

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* 8. Would you recommend mediation to a friend or relative?

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* 9. Did you find the process helpful?

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* 10. Because of mediation do you feel you have a better understanding of the situation, the other person, and/or yourself?

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* 11. What were the most beneficial aspects of your mediation?

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* 12. What were the main drawbacks of your mediation, if any?

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