Evaluation of Mediation Session(s) and Mediator (s) Session Evaluation Question Title * 1. Name: Question Title * 2. Date: Date / Time Date Question Title * 3. Address and Phone Number: Address Address 2 City/Town State/Province ZIP/Postal Code Phone Number Question Title * 4. I am : a party to the dispute an attorney representing a party Question Title * 5. For this case, mediation was: very appropriate somewhat appropriate not at all appropriate Question Title * 6. Total hours spent in the mediation session(s): Question Title * 7. Number of Sessions: Question Title * 8. The mediation process was: Very helpful Somewhat helpful Not at all helpful Question Title * 9. Mediation ended with an agreement on: all of the issues some of the issues none of the issues Question Title * 10. Would you use mediation again? Yes No Question Title * 11. Would you recommend mediation to others? Yes No Question Title * 12. Mediator Name: Question Title * 13. Mediator Certification Number (If known): Question Title * 14. The mediator explained the mediation process and procedures. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 15. The mediator provided useful information. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 16. The mediator was a good listener. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 17. The mediator allowed me to talk about issues that were important to me. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 18. The mediator was respectful. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 19. The mediator helped clarify issues. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 20. the mediator encouraged us to come up with our own solutions. Poor Unsatisfactory Adequate Good Very Good Poor Unsatisfactory Adequate Good Very Good Question Title * 21. The mediator informed me that I could consult an attorney yes no Question Title * 22. The mediator was neutral. yes no Question Title * 23. The mediator wrote our agreement clearly and accurately. Yes No doesn't apply Question Title * 24. Share any comments on the mediation process and/or the mediator (s) Done