On-site Mediation Intake Form
(same day of court case)

This form is private and confidential. It is provided as part of a confidential mediation process. The only exception will be if the safety of a child is at risk or if there are threats of imminent harm to another person. 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.

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)


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

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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 5X5Main Floor (Just east of Yonge, south side of Sheppard)

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