Schedule A Virtual Mediation

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Schedule a Virtual Mediation
Choose a Mediation Date*
MM slash DD slash YYYY
Choose a Start Time*
Case Style*

Please do not use : / ? # [ ] @ ! $ & ' ( ) * + , ; = as characters in your case style.
Case Type*
County*
State*
Case Number
Court
Is this a court-ordered mediation?
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- Yes
- No
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How many parties are involved in the disputes to be resolved at this mediation?*

2 Parties Example: One Plaintiff, one Liability Carrier is two (2) parties.

3 Parties Example: One Plaintiff, one Liability Carrier and one UM Carrier is three (3) parties.

4+ Parties Example: 1 Plaintiff and 3 Defendants is four (4) parties.
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How much time will you need?*
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How much time will you need?

Please Note: To ensure quality of mediation, cases with 4 or more participating parties require 5 hours.
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Time*
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Demand Offer*
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Do you have a preferred mediator?
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*
- I understand this is only a request; if my preferred mediator is unavailable, the mediation will be randomly assigned to another ADR On-Demand mediator.

Party Details
Who do you represent?
Select a side*
- Represents the Plaintiff
- Represents the Defense
Scheduling Attorney
Scheduling Attorney*
Firm Name
Representing*
Insurance Carrier*
Attorney's Email*
Paralegal/Assistant Email
Scheduling Attorney's Phone*
Opposing Counsel
Defense Attorney*
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Representing*
- Represents the Plaintiff
- Represents the Defense
Insurance Carrier
Plaintiff's Attorney*
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Representing*
- Represents the Plaintiff
- Represents the Defense
Representing*
Attorney's Email*
Paralegal/Assistant Email
Opposition Attorney's Phone
Add Third-Party Counsel Information

Please include attorney name, email, and phone number for any additional billiable parties.
Additional Party Info

Please provide payment information.
Payment Method*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Address*
Street Address Address Line 2 City State ZIP Code
Agreements*
- By attending mediation, I agree to ADR On-Demand's Agreement to Mediate Online.
Agreements*
- This fee is non-refundable if canceled within 24 hours of the scheduled mediation.
Agreements*
- I understand the mediation will not exceed 3 hours.
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Agreements*
- I acknowledge that this mediation will be cancelled if payment is not received at least 48 hours before the scheduled mediation (notification will be sent only in the event of cancellation)
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Promo Code
Companion Case Information
3-Hour Virtual Mediation Fee
3-Hour Virtual Mediation Fee*
Price:
5-Hour Virtual Mediation Fee*
Price:
Total
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Status
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$0.00
Name
This field is for validation purposes and should be left unchanged.

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