With this unique, powerful form, capture mediation parties’ information whilst priming them for constructive engagement, increasing the chances the mediation process won’t fizzle out before it begins. Enter your details below securely here to help us create your dedicated page swiftly and accurately, add to basket then checkout, and we’ll send you the link to your dedicated form usually within two working days.

upload your logo or image

When they visit the link to your dedicated page, your mediation parties will feel more secure if they see your logo or face. Upload an image for us to place on the page.

(max file size 64 MB)

enter your full name

Your name will be placed on the page so that your mediation clients know they’ve reached the right place. Please enter it here.

enter your email address

Once we have your email address, we will email you to let you know once the page is live. You will then be able to review it and let us know if you wish us to make any changes before you begin using it. Per our privacy policy, your details are fully secure.

enter any other details

Here you should let us know of any other information you wish us to add to your dedicated page. For example, this could be a link to your policies or website, or directions to your office, contact details and so on. Enter the details here, then click ‘Add to Basket’.


Getting a mediation up and running is often the most difficult part of the process. We know this. So what if, with every referral you pick up, you could send the parties right away to a simple, secure but optimised form, with your details and branding, that would not only capture their information but would also prime them to believe in the process and reach the mindset needed for constructive engagement?

Your pocketmediationintake does all this and more. Access it today and wave goodbye to non-starts, no-shows and referral forms ‘lost in the post’!

  • the form has your details & branding
  • you can signpost parties to your terms of business & website
  • customising the form to your taste is a breeze
  • you send parties the link to the form
  • the parties then complete it anywhere they are
  • the information comes to you immediately
  • crucially, the parties will be primed to begin mediating
  • privacy guaranteed for you and the parties