Off-site Family Mediation Intake Form (no court case required)

This form is strictly confidential and is provided to us as part of a confidential (closed) mediation process. The only exceptions are if a child is at risk of harm, any person is in imminent danger or a judge orders disclosure of this information. It will help us assign the best-suited mediator to your file. It will be read only by the mediator and our staff. IMPORTANT: Each party is required to fill out and submit their own form.

A PDF version of the Intake Form is available: Intake Form (PDF)

Family Law Information Centres (FLIC)

You can learn much more about available services, mediation, court process, separation,
divorce and the law by visiting us at one of our Family Law Information Centres (FLIC)


393 University Avenue, Suite 900 Toronto, Ontario M5G 1E6

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311 Jarvis Street Toronto, Ontario, M5B 2C4

(Between Gerrard and Dundas)

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47 Sheppard Avenue East Toronto, Ontario M2N 5X5

Main Floor (Just east of Yonge, south side of Sheppard)

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