Mediation Consent Agreement

Mediation Consent Agreement(Required)
You are required to read through the following terms and conditions. When you have reach the end, checking the box will satisfy the agreement to be submitted.


The mediator(s) and the clients enter into this contract voluntarily. The mediator and the clients agree that they have no prior personal or business relationships, and there are no known potential conflicts of interest.


A. Role of the Mediator(s):

The mediator(s) serve as a neutral third-party to assist in reaching clear and lasting resolutions to conflict. All issues will be addressed in the context of the clients’ goals and interests.

The mediator(s) provide a structured setting for a productive exchange of information with the goal of identifying settlement options.

An agreement shall be reached only if both clients agree to terms that they deem fair, reasonable, and in the best interest of both clients and of their child(ren).

The mediator(s) hold no authority to impose an agreement on any matter.

The mediator(s) hold no liability for any outcomes or consequences resulting from the mediation process or terms of any mediated agreement.

The mediator(s) hold all content of the mediation as confidential. A release of information is required to share information with any other party.

The mediator(s) does not serve as an expert or witness in any court proceeding.

The mediator(s) does not give legal advice. If this agreement is to be made a court order, the clients must seek legal counsel to complete the proper paperwork and follow required procedures.

Interim Agreements. During the transition period from engaging in mediation to final resolution, the mediator(s) will assist the clients in making interim agreements for housing, co-parenting, and cash flow as needed.

Parenting Matters. The mediator(s) will invite the clients to discuss the best interests of the children and potential solutions to            co-parenting issues. The mediator(s) may cite research and otherwise educate the clients on matters of child development, best practices of positive parenting, and strategies for successful co-parenting. The mediator(s) may share ideas for solutions that work well for other families. All required information for a parenting plan will be reviewed as a potential topic for discussion.

Housing and Financial Matters. The mediator(s) will work with the clients to identify all assets, debts, income, expenses and property relevant to the partnership. The mediator(s) may utilize a marital balance sheet, cash flow reports, child support worksheets and other illustrations to assist the clients in understanding the implications of financial decisions. The mediator(s) will provide resources or otherwise educate the clients on financial and tax matters as needed. All required information for a separation agreement will be reviewed as a potential topic for discussion.

B. Role of the Client(s):

The clients determine the issues to be discussed in mediation. The clients set the goals for each mediation session.

The clients will answer the mediator’s questions as completely and honestly as possible and engage in the mediation process to the fullest extent possible.

The clients will make a good faith effort to be open to ideas that may promote a settlement and parenting plan in the best interests of their child(ren).

Either client may include support persons in the mediation with consent of the other client.

The clients are encouraged to only exchange proposals in the mediation sessions unless otherwise directed by the mediator(s).


A. Appointments: Appointments with the mediator(s) shall be scheduled at the request of the clients. Mediation sessions may take place with both clients present and/or with each parent individually. Standard mediation appointments are 120 minutes in length. Additional conversations may take place by telephone.

B. Communication: The clients may contact the mediator(s) by telephone, email or text message. The mediator(s) will make every effort to respond within 2 business days.

C. Confidentiality: All communication between the mediator(s) and clients is confidential and may not be used in any court proceeding. Either client may request a conversation or meeting with the mediator(s) without the knowledge or consent of the other client. All communications between the mediator(s) and the clients will be private and confidential unless a release of information has been signed and submitted to the mediator(s) for the purpose of communicating with other parties.

D. Cancelled or missed appointments: The clients shall pay in full for any cancelled or missed appointments unless 24-hour cancellation notice is given.


Clients shall pay for appointments at the time of service. Alternative arrangements may be made at the request of the clients. Unless otherwise stated in a separate engagement letter, fees for appointments are $250.00 per hour for individual or joint appointments. Fees for additional time spent in telephone or email conversations are billable at $250.00 per hour, calculated at          10-minute intervals. The mediator(s) will notify the clients before any charges are accumulated for telephone conversations or email exchanges. The mediator(s) shall bill the clients promptly with an itemized statement for telephone conversations and email exchanges.


Client(s) understand that the mediator(s) are obligated under law to disclose the following information to appropriate authorities:
1) allegations of abuse or neglect of a child, 2) threats of harm to other people or yourself, 3) statements made indicating plans to carry out or hide an ongoing crime, and 4) statements made that reveal a felony crime.

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951 High Street Suite B Worthington, Ohio 43085