NO COURT DATES. NO ATTORNEY'S FEES.

LESS HASSLE. LESS EXPENSE.

RESOLVE THESE ISSUES AND MORE  WITH A MEDIATED SETTLEMENT AGREEMENT

  • PROBLEMS WITH YOUR LANDLORD OR TENANT?

  • NEED TO REVISE YOUR PARENTING PLAN?

  • FIGHTING WITH YOUR NEIGHBOR?

UNSURE IF MEDIATION IS RIGHT FOR YOUR DISPUTE?

 WHY NOT FIND OUT FOR FREE FROM THE SAFETY AND PRIVACY OF HOME?

  • No risk.

  • No pressure.

  • No gimmicks.

  • No credit card or personal contact.

  • Just Answers.

 

Take 5 minutes to complete the form below in order to request your free 30-minute phone consultation. Speak to a trained mediator with a professional reputation to uphold, so you can rest easy knowing that you will not be "sold" on unnecessary services.

AMID THIS GLOBAL CRISIS AND COVID PANDEMIC, YOUR HEALTH AND WELL-BEING ARE #1 PRIORITY, WHICH IS WHY MAZZOLA MEDIATION IS NOW OFFERING VIDEO AND TELECONFERENCING OPTIONS FOR ALL MEDIATIONS.

MEDIATION CONSULTATION QUESTIONNAIRE

PURSUANT TO THE FLORIDA MEDIATION CONFIDENTIALITY AND PRIVILEGE ACT, MAZZOLA MEDIATION, PLLC DOES NOT DISCLOSE CONFIDENTIAL INFORMATION PROVIDED DURING, OR IN CONTEMPLATION OF, MEDIATION WITHOUT CLIENT CONSENT EXCEPT AS REQUIRED OR PERMITTED BY LAW UNDER SECTIONS 44.401-.406, FLORIDA STATUTES. 


THIS FORM IS FOR VERIFICATION PURPOSES ONLY AND IS NOT INTENDED TO ELICIT PERSONAL OR PRIVILEGED INFORMATION. YOUR ANSWERS WILL BE USED SOLELY TO ASSESS WHETHER MAZZOLA MEDIATION’S SERVICES ARE APPROPRIATE AND COMPATIBLE WITH THE NATURE OF YOUR DISPUTE. 

CONTACT INFORMATION

IS IT OKAY TO LEAVE A VOICE MESSAGE?
IS IT OKAY TO LEAVE A MESSAGE WITH A MEMBER OF YOUR HOUSEHOLD?

MEDIATION SUBJECT MATTER

arrow&v
DO YOU HAVE ANY SAFETY CONCERNS INVOLVING THE OTHER PARTY?

LEGAL PROCEEDINGS

HAS A COURT CASE BEEN FILED REGARDING YOUR DISPUTE?
HAVE YOU BEEN ORDERED BY A COURT TO ATTEND MEDIATION?
ARE YOU REPRESENTED BY AN ATTORNEY?
IS THE OTHER PARTY TO YOUR DISPUTE REPRESENTED BY AN ATTORNEY??

ACKNOWLEDGMENT & SIGNATURE

SIGN WITH FINGER OR MOUSE

Mazzola Mediation, PLLC

Mazzola Mediation, PLLC

936 US Highway 1  Suite C

Sebastian, Florida 32958

772-242-4200

  • Mazzola Mediation, PLLC FACEBOOK
  • Mazzola Mediation, PLLC

©2020 by Mazzola Mediation, PLLC