CEDR mediation referral form

Please complete the following fields and submit to one of our experienced Client Advisers. All information supplied on this form is transmitted via our secure server and is encrypted for maximum security. Please choose from the following options: (Fields marked * are required.)

Choose one of the following options *

I would like CEDR to appoint the most appropriate mediator for my case.

Our appointment service is ideal for cases where the parties want CEDR to appoint the mediator on their behalf. We will take in to account any specific requirements the parties may have as to any sector expertise and experiences required of the mediator. This service is free of charge. The mediator's hourly rate is discussed with you prior to appointment. Fees are due once the case has been confirmed according to our terms and conditions.

I know the mediator I wish to appoint.

CEDR has exclusive relationships with more than 30 mediators via its CEDR direct group. Parties can review each member by sector and industry expertise via the mediator directory and either appoint the mediator they want by going direct to them or by telling CEDR the name of the mediator they require. There is no appointment fee when appointing your mediator direct from the direct group.

I would like CEDR to recommend three mediators for me to choose from.

Under our recommendation service we will recommend three mediators from the CEDR panel who demonstrate the correct background and expertise to mediate your dispute. You then have the option of selecting one of them to mediate your dispute, after consultation with the other party or parties. This service is free of charge for each party. The mediator's hourly rate is discussed with you prior to appointment. Any fees are due once the case has been confirmed according to our terms and conditions.

I would like guidance from CEDR.

If you are not sure whether you want us to appoint, you don't want to appoint from our direct group, or you'd like more information about our recommendation service, please contact a Client Adviser on 020 7536 6060 or by email at adr@cedr.com.

From
Name *
Company/law firm *
Email *
Phone *
Location † *
	† e.g. East, South East, Midlands, Europe

Details
Dispute type *
Brief description * (or a longer description may be optionally uploaded as a Word document file)
Upload optional file
Please enter the amount in dispute (claim plus counter-claim) or check 'No monetary value'.
* £
	No monetary value
Likely location /city/town/venue for the mediation *
Availability period
Mediator (if known)
Mediator (if not above)
CEDR contact ‡
Any other information (half or full day, court timetable, etc.)
What prompted you to approach CEDR? *

Or other

‡ If you have spoken to someone at CEDR about this dispute then please enter their name.

Party A
Name
Insurer (if any)
Law firm (if any)
Contact name
Phone
Email

Party B
Name
Insurer (if any)
Law firm (if any)
Contact name
Phone
Email

Party C (if applicable)
Name
Insurer (if any)
Law firm (if any)
Contact name
Phone
Email

Party D (if applicable)
Name
Insurer (if any)
Law firm (if any)
Contact name
Phone
Email

Please carefully check all information, especially your own email address, that you have supplied on this form. You may also wish to print a copy for your records before clicking the Submit button. All information supplied is transmitted via our secure server and is encrypted for maximum security.

Alternatively print this form and fax it to:
CEDR
Fax +44 (0)20 7536 6061
Email adr@cedr.com

CEDR mediation referral form

Mediation service required

From

Details

Party A

Party B

Party C (if applicable)

Party D (if applicable)

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