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* 1. Date of Mediation

Date

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* 2. Where was your case filed?

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* 3. Who was your mediator?

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* 4. Type of Case

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* 5. I am a:

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* 6. Overall how satisfied are you with the mediator?

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* 7. Overall, how satisfied are you with the mediation process?

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* 8. I was able to share my thoughts and concerns.

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* 9. How likely are you to use mediation again?

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* 10. How was this mediation conducted?

T