Thank you for your interest in our divorce mediation services and for taking the time to fill out this form.  Information supplied on this form will be held in confidence and will be sent directly to MWI's Director of Mediation Services, Josh Hoch, via our secure server.  Josh will contact you within two business days after you submit the form.

Please contact Josh at 800-348-4888 x23 or jhoch@mwi.org with questions.  

Thank you.

A. Contact Information 

First Name:

Last Name:

Contact Phone:

Email:

How would you prefer to be contacted? phone  email

other?

B. Overview (this section is optional).

1) Have you discussed divorce or separation with your spouse or partner?
Yes  No

2) Are you still living together?
Yes  No

3) Have you filed for divorce?
Yes  No

4) Please describe the topics that you think might be difficult to resolve with your spouse or partner: 

5) If applicable, please indicate the names and ages of the children you have together: 

6) Please describe when you would prefer to mediate (for example, Monday mornings or Saturday afternoons, etc...)

7) Do you have any questions or is there anything else that you would like Josh to know?

Verification Code

Type the code you see above:
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Thank you for taking the time to fill out this form.  Josh will contact you within two business days.

Please contact Josh Hoch at 800-348-4888 x23 or <jhoch@mwi.org> with questions.