Mediation
Intake Form
Basic Instructions for Completing
Mediation Intake Form:
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Please complete the form to the best
of your knowledge.
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Please leave the following area
blank: "Mediation No."
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Do not write on the form below
the section labeled "Claimant's Statement."
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Please mail the completed form
to:
Fairfield County Municipal
Court
Attention: Mediator
104 E. Main Street
Lancaster, Ohio 43130
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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.
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Mediation is held on Wednesday
at noon in the jury trial room, located in the lower level
(basement) of the City Building.
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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.
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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.
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As an alternative you may email
[email protected]
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
Word)
Also available is an explanation of mediation. Please choose one of the links below:
What is Mediation? (Adobe .PDF)
What is Mediation? (Microsoft Word)
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