Basic Instructions for Completing
Mediation Intake Form:
Please complete the form to the best
of your knowledge.
Please leave the following area
blank: "Mediation No."
Do not write on the form below
the section labeled "Claimant's Statement."
Please mail the completed form
Fairfield County Municipal
104 E. Main Street
Lancaster, Ohio 43130
Upon the mediator receiving your
document, he will contact you in order to discuss the
issue(s) at hand and schedule any necessary mediation hearings.
Mediation is held on Wednesday
at noon in the jury trial room, located in the lower level
(basement) of the City Building.
The claimant is the person(s) who
is claiming that a monetary or material item is owed to them, and
they are the party and/or applicant(s) requesting mediation.
The respondent(s) is the person(s)
that the claimant is attempting to enter into an agreement in
efforts to resolve the issue(s) at hand.
As an alternative you may email
for online instructions.
The mediation intake form is
available in either an Adobe .PFD or a Microsoft Word Document.
Please choose one of the links below:
Mediation Intake Form (Adobe .PDF)
Mediation Intake Form (Microsoft
Also available is an explanation of mediation. Please choose one of the links below:
What is Mediation? (Adobe .PDF)
What is Mediation? (Microsoft Word)