Please review all questions before you begin. Your answers are JOINT COMMUNICATION
and will be used to compile a list of issues for discussion during mediation. If you wish any
portion of your answers held PRIVATE, please indicate clearly. Attach another sheet of
paper as needed.
nature of the conflict
to be mediated, from
your perspective:
perspective, list the
various issues
involved in the
conflict: (example:
level of care Dad
requires; who will pay
for his care; should
Dad still be driving;
where should Dad
live; who will handle
Dad's money: should
his new wife alone
inherit his assets?)
underlying interests
that need to be met
for the conflict to be
resolved fairly?
interests do you
have in common with
one or more of the
others involved in the
conflict?
you taken to attempt
to resolve the conflict
so far?
options do you
suggest for resolving
the conflict?
you wish all or part of
this communication
held PRIVATE.
