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Premier ADR
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Intake form
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Name
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Email address
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Phone number
Preferred method of contact
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Email
Phone
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Type of mediation needed
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Family Mediation
Business Mediation
Workplace Mediation
Community Mediation
Divorce Mediation
Availability for mediation sessions
Brief description of the issue
Have you previously participated in mediation?
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Yes
No
If yes, please provide details
How did you hear about us?
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Referral
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Are you open to online mediation?
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Yes
No
Preferred language for mediation
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English
Spanish
French
Additional questions or comments
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