Start Afresh Mediation For the file — mediator’s record

MIAM Assessment Record — Part 2

Mediator

Client

Date

Confidentiality and ground rules

Client confirms they are alone, cannot be overheard, and are not recording this meeting Exceptions to confidentiality explained (risk to any person; criminal activity)

Safeguarding

Was domestic abuse a problem in the relationship?

Have the police been involved?

Is there a safeguarding concern?

Are social services involved?

Any non-molestation order, restraining order, prohibited steps order, or other order in place?

Alcohol

Yes No

Drugs

Yes No

Other addictions

Yes No

Legal aid assessment

Completed by the mediator.

Employment

Other sources of income

Benefits

Qualifies?

Yes No

Information about legal aid mediation provided

Client’s comments

General information

Read aloud — impartiality

There is limited contact between me and my clients. Please treat me as any other professional and do not try to cross the professional boundaries, as it may result in me not being able to be your mediator.

Kontakt między mną a moimi klientami jest ograniczony. Proszę traktować mnie jak każdego innego profesjonalistę i nie próbować przekraczać granic zawodowych, ponieważ może to spowodować, że nie będę mogła być Państwa mediatorem.

Information & not advice Your own responsibility Voluntary Shuttle / together — options explained Other NCDR options mentioned: hybrid/integrated mediation, arbitration, neutral evaluation, collaborative law, solicitor negotiation

Client comments

Explained

What the client wants to discuss

Review of an existing agreement or order Children and managing parenting Financial / property issues Debt or other financial hardship

Next steps

Invitation to Client 2

Deadline for Client 2

Update to Client 1

If Client 2 says no or doesn’t respond: client can request Form A or C100 at £85.
If Client 2 says yes: send documents to sign, and mediation begins.

Very important — read aloud: From now on I cannot have any contact with you outside of sessions. If you need a repeat of information, it is available at an additional cost. You have my price list.

Recommendations for professional representation and support

Represented by a solicitor?

Yes No

If yes, their details

Any professional support received — counselling or personal/relationship support? From whom? Individual, couple, or family?

Is that support continuing?

Yes No

Confidentiality and ground rules

Safeguarding

Legal aid assessment

General information

What the client wants to discuss

MIAM outcome

Next steps

Recommendations for professional representation and support