CREATIVE MEDIATION, L by 11yflme

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									                                  CREATIVE MEDIATION, L.L.C.
                                     400 Travis Street, Suite 300
                                    Shreveport, Louisiana 71101
                                           (318)422-2240

                             PRE-MEDIATION INFORMATION FORM

 (Please Complete and Reply by Email or Bring to the First Mediation Session. Please give me a call if
                              you need help in completing this from.)

YOUR NAME:
SPOUSE’S (OR FORMER SPOUSE’S) NAME:
DATE OF MARRIAGE:
LOCATION OF MARRIAGE:
ARE YOU NOW SEPARATED OR DIVORCED?
IF SEPARATED, PLEASE STATE THE DATE OF SEPARATION:
IF DIVORCED, PLEASE STATE THE DATE OF DIVORCE:
WHO IS THE JUDGE IN YOUR CASE?
WHAT IS THE DOCKET NUMBER OF YOUR CASE?
IS THERE AN EXISTING CUSTODY ORDER?
HOW MANY CHILDREN ARE THE SUBJECT OF THIS MEDIATION?
PLEASE GIVE NAMES AND AGES OF EACH CHILD:
      CHILD #1:
      CHILD #2:
      CHILD #3:
      CHILD #4:
BRIEFLY STATE THE ISSUES OR DISPUTES YOU WISH TO DISCUSS IN MEDIATION:
      ISSUE #1:


      ISSUE #2:


      ISSUE #3:


      ISSUE #4:


      ISSUE #5:


      ISSUE #6:

								
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