Parenting Mediation Assessment

LEGAL NOTICE

Please read our FDR Booklet, our Privacy Policy and Website Terms of Use before proceeding with the Mediation for Families™ Intake & Assessment.

FDR Booklet

I have read the FDR Information Booklet

Exclusion of Liability & Indemnity

I consent to the Exclusion of Liability & Indemnity Terms

Terms of Use

I consent to the Terms of Use

Privacy Policy

I consent to the Privacy Policy.

Confidentiality & Admissibility

I agree to and understand the Confidentiality & Admissibility provisions.

YOUR DETAILS

Your name(Required)

First Last

Nationality(Required)

Gender(Required)

D.O.B(Required)

Address(Required)

Street Address City Postcode

State(Required)

Email(Required)

Enter Email Confirm Email

Hidden

Phone(Required)

Hidden

Phone(Required)

Do you require an interpreter?(Required)

Yes

No

Preferred contact time(Required)

AM

PM

OTHER PARTY DETAILS

Other party name(Required)

First Last

Nationality(Required)

Gender(Required)

D.O.B(Required)

Last Known Address(Required)

Street Address City Postcode

State(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

This party is aware that I am going through the FDR process.(Required)

Yes

No

EMERGENCY CONTACT DETAILS

Title(Required)

Name(Required)

First Last

Relationship(Required)

Email(Required)

Phone(Required)

CHILDRENS DETAILS

Children of the relationship

This includes children of the relationship. Step and half siblings are detailed in the next step.

How many children?(Required)

Child 1

Name(Required)

First Last

D.O.B(Required)

Gender(Required)

Does the child have any specific routines?(Required)

Does the child have any known health issues?(Required)

What activities and hobbies does the child participate in?(Required)

Does the child have any best friends?(Required)

What is the child's sleep and eating schedule?(Required)

What days do you have the child?

Frequency of time spent(Required)

Child 2

Name(Required)

First Last

D.O.B(Required)

Gender(Required)

Does the child have any specific routines?(Required)

Does the child have any known health issues?(Required)

What activities and hobbies does the child participate in?(Required)

Does the child have any best friends?(Required)

What is the child's sleep and eating schedule?(Required)

What days do you have the child?

Frequency of time spent(Required)

Child 3

Name(Required)

First Last

D.O.B(Required)

Gender(Required)

Does the child have any specific routines?(Required)

Does the child have any known health issues?(Required)

What activities and hobbies does the child participate in?(Required)

Does the child have any best friends?(Required)

What is the child's sleep and eating schedule?(Required)

What days do you have the child?

Frequency of time spent(Required)

Child 4

Name(Required)

First Last

D.O.B(Required)

Gender(Required)

Does the child have any specific routines?(Required)

Does the child have any known health issues?(Required)

What activities and hobbies does the child participate in?(Required)

Does the child have any best friends?(Required)

What is the child's sleep and eating schedule?(Required)

What days do you have the child?

Frequency of time spent(Required)

Additional children

Provide details of any additional children of relationship

Please include the same details outlined above (name, gender, age etc)

Half & Step Siblings(Required)

Please include the same details outlined above (name, gender, age etc)

SCHOOLING

How are your children educated?(Required)

Attend a school

Home schooled

Select school(Required)

HOW ARE THE CHILDREN COPING?

Relationships

Please describe the relationship that the children have with the other party.(Required)

Please describe the relationship that the children have with other important people?(Required)

This could include (but not limited to) their grand parents, cousins, your current partner, uncles and aunts.

Dealing with the separation

How are the children dealing with the separation/divorce?(Required)

Have the children received professional assistance?(Required)

This could include assistance from a counsellor, social worker, psychologist and a psychiatrist.

Yes

No

Who has the child(ren) seen?

Are they still seeing them?(Required)

Yes

No

Would you like some referral information?(Required)

These may include details of practitioners or information sheets that may assist in making the separation easier on your children.

Yes

No

Have you spoken to the children about the separation/divorce?(Required)

Yes

No

What questions did the children ask?(Required)

Would the children benefit from speaking to someone about the separation and any impact its had on them?(Required)

Yes

No

Would you like a referral to a practitioner?(Required)

Yes

No

Which practitioner(s) do you think would be beneficial?(Required)

Is there anything else important you'd like to add regarding the children coping with the divorce/separation?(Required)

Yes

No

Please explain(Required)

FUTURE ARRANGEMENTS

How does future parenting look to you?(Required)

What do you hope for?(Required)

What options could you suggest if other party does not agree?(Required)

Are you aware of what the other party may propose?(Required)

What would you not agree to?(Required)

Have you discussed this with your Legal Practitioner?(Required)

Is there anything else important regarding how you see future arrangements?(Required)

Yes

No

Please describe.(Required)

ISSUES FOR MEDIATION

Should you be assessed as eligible for family dispute resolution please list the 5 most important issues (in order of priority) that you would like to resolve with the other party. Keep these brief and to the point.

Issue 1(Required)

Issue 2(Required)

Issue 3(Required)

Issue 4(Required)

Issue 5(Required)

ACKNOWLEDGMENT OF INFORMATION RECEIVED

Acknowledgment of information received.(Required)

I have read the 'Family Dispute Resolution Conference Booklet' provided to me.

I have received information outlining that it is not the role of a Family Dispute Resolution Practitioner to provide legal advice.

I have received information outlining the obligations of a Family Dispute Resolution Practitioner in respect of confidentiality and disclosure under s 10H of the Family Law Act 1975.

I have received information in respect of the Family Dispute Resolution Practitioners fees for the Family Dispute Resolution process.

I have received information that family dispute resolution must be attended if required under section 60I of the Family Law Act 1975 before applying for an order under Part VII of the Act.

I acknowledge that I have been provided with all of the above.

Aboriginal and Torres Strait Islander health practitioner
Accredited exercise physiologist
Arts therapist
Audiologist
Chinese medicine practitioner
Chiropractor
Dietician
Medical radiation practitioner
Music therapist
Occupational therapist
Optometrist
Osteopath
Other
Pharmacist
Physiotherapist
Podiatrist
Psychologist
Rehabilitation counsellor
Social worker
Speech pathology
Other

1300 LETS CHAT

Email Us

Mon - Fri 9:00am - 5:00pm

CALL US NOW