Phone: 020 8556 6200 E-mail: admin@wpmed.org

Contact us:

Phone:
020 8556 6200

Fax:
020 8556 5011

E-mail:
admin@wpmed.org

Post:
Workplace Mediation Ltd,
Zenith House,
210 Church Road,
London E10 7JQ

Referral Form

Do you have a dispute that needs resolving?

Fill out this form with as much information as possible and submit it.
After reviewing your information we will contact you.

We will also be offering the Referral Form in PDF and DOC format in the near future.

Referring Information

Referring Agency:

Address:

Post Code:

Tel:

Fax:

Email:

Referring Officer:

Title:


Client Information (first party)

Has the client agreed to participate in mediation?

Name:

Address:

Post Code:

Home Tel:

Work Tel:

Mobile:

Special requirements: e.g. interpreter, and disabilities

Client Information (second party)

Has the client agreed to participate in mediation?

Name:

Address:

Post Code:

Home Tel:

Work Tel:

Mobile:

Special requirements: e.g. interpreter, and disabilities

Nature of the dispute

Please give a brief outline of the dispute:

Further Information

If you think we should know anything else, please use this section:



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