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. Otherwise, we will not share any of this information without your consent. This information may be used for research or training purposes with all identifying information removed.

IMPORTANT: Each party is required to fill out and submit their own form.

[DISCLAIMER: DESPITE OUR BEST EFFORTS, WE CANNOT GUARANTEE THAT ALL INFORMATION SUBMITTED ELECTRONICALLY IS 100% SECURE AND PRIVATE]

*Please note: it will take you approximately 15 minutes to fill out this form. Please have PDF or JPEG copies of the following documents on hand (if applicable), so you can upload them when prompted:

  • Court File Number (top-right of your court documents) and court location (311 Jarvis, 47 Sheppard, or 361 University Ave., or “other”)
  • Three most recent Court Orders
  • Three most recent Endorsements
  • Referral to mediation (from your judge)
  • Separation Agreement
  • A Form 13 or 13.1 (Financial Statement)
  • Bail conditions / No Contact Order / Probation Order / Peace Bond / Parole Order / Notice of Recognizance
  • OCL Report / Voice of the Child Report / Parenting Assessment (private) / Children’s Aid Report or letter / Children’s Aid Society Worker’s name, address and telephone number
  • Your lawyer’s name, email address, and phone number (if you have a lawyer)

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)

416-977-0718

361 University Ave, Suite 146, Toronto, ON M5G 1T3

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416-326-1694

311 Jarvis Street Toronto, Ontario, M5B 2C4(Between Gerrard and Dundas)

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416-250-6161

47 Sheppard Avenue East Toronto, Ontario M2N 5X5Main Floor (Just east of Yonge, south side of Sheppard)

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