This information will be used to inform the court system and the mediator(s) about your experience with mediation. With your help, we can ensure that quality mediation services continue to be available to the citizens of the Commonwealth. This information may be shared with the mediator(s).

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* 1. Personal Information

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* 2. I am (check one)

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* 3. For this case, mediation was (check one):

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* 4. Time

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* 5. The mediation process was:

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* 6. Mediation ended with an agreement on:

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* 7. Would you use mediation again?

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* 8. Would you recommend mediation to others?

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