{"id":1042,"date":"2022-12-08T15:49:09","date_gmt":"2022-12-08T15:49:09","guid":{"rendered":"https:\/\/becketmediation.co.uk\/?page_id=1042"},"modified":"2023-02-02T12:13:34","modified_gmt":"2023-02-02T12:13:34","slug":"family-mediation-referral","status":"publish","type":"page","link":"https:\/\/becketmediation.co.uk\/family-mediation\/family-mediation-referral\/","title":{"rendered":"Family Mediation Referral"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f9-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/1042#wpcf7-f9-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"9\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f9-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<p><i>Please note \u2013 information on this form will be shared with your (ex) partner unless you specifically indicate otherwise.<\/i>\n<\/p>\n<h3>1. Your personal details\n<\/h3>\n<div class=\"form-cols\">\n\t<p><label for=\"full-name\">Full name <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"full-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"full-name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"full-name\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"name-at-birth\">Family name at birth (if different)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name-at-birth\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"name-at-birth\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name-at-birth\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"dob\">Date of Birth <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"dob\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"dob\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"ni-number\">NI Number<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ni-number\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"ni-number\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ni-number\" \/><\/span>\n\t<\/p>\n<\/div>\n<h3>2. Confidentiality\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"not_share-info\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"not_share-info[]\" value=\"Before mediation can proceed we usually arrange to share the contents of this Referral Form with your partner\/former partner. Please tick this box if you would prefer we did not do so at this stage.\" \/><span class=\"wpcf7-list-item-label\">Before mediation can proceed we usually arrange to share the contents of this Referral Form with your partner\/former partner. Please tick this box if you would prefer we did not do so at this stage.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"not_share_contact\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"not_share_contact[]\" value=\"Please tick this box if you would like us to keep your private address or telephone number confidential from your partner\/former partner.\" \/><span class=\"wpcf7-list-item-label\">Please tick this box if you would like us to keep your private address or telephone number confidential from your partner\/former partner.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h3>3. Stage of Proceedings\n<\/h3>\n<p><label>Are you consulting a solicitor? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"is-consulting-solicitor\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"is-consulting-solicitor\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"is-consulting-solicitor\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"solicitor-consult\">If so, please give us his\/her name, address and telephone number<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"solicitor-consult\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"solicitor-consult\" aria-invalid=\"false\" name=\"solicitor-consult\"><\/textarea><\/span>\n<\/p>\n<p><label>Are you currently involved in divorce or other family or children proceedings? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"current-proceedings\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"current-proceedings\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"current-proceedings\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"stage-reached\">If so, what stage have they reached?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"stage-reached\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"stage-reached\" aria-invalid=\"false\" name=\"stage-reached\"><\/textarea><\/span>\n<\/p>\n<p><label>Have you and\/or your partner\/former partner had any form of relevant counselling\/therapy or involved any other professionals (e.g. Relate, Social Services)? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"relevant-therapy\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"relevant-therapy\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"relevant-therapy\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"other-involved\">If yes, please give details of the other professionals involved<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-involved\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"other-involved\" aria-invalid=\"false\" name=\"other-involved\"><\/textarea><\/span>\n<\/p>\n<p><label for=\"heard-about\">Where did you hear about mediation? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"heard-about\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"heard-about\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"heard-about\" \/><\/span>\n<\/p>\n<h3>4. Contact Information\n<\/h3>\n<p><label for=\"home-address\">Home Address <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"home-address\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" id=\"home-address\" aria-required=\"true\" aria-invalid=\"false\" name=\"home-address\"><\/textarea><\/span>\n<\/p>\n<div class=\"form-cols\">\n\t<p><label for=\"home-tel\">Tel <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"home-tel\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"home-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"home-tel\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"home-fax\">Fax<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"home-fax\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"home-fax\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"home-fax\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"home-email\">Email <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"home-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" id=\"home-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"home-email\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"home-mobile\">Mobile<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"home-mobile\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"home-mobile\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"home-mobile\" \/><\/span>\n\t<\/p>\n<\/div>\n<p><label for=\"work-address\">Work Address<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"work-address\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"work-address\" aria-invalid=\"false\" name=\"work-address\"><\/textarea><\/span>\n<\/p>\n<div class=\"form-cols\">\n\t<p><label for=\"work-tel\">Work Tel<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"work-tel\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"work-tel\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"work-tel\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"work-fax\">Work Fax<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"work-fax\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"work-fax\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"work-fax\" \/><\/span>\n\t<\/p>\n<\/div>\n<p><label for=\"work-email\">Work Email<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"work-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" id=\"work-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"work-email\" \/><\/span>\n<\/p>\n<p><label for=\"best-contact\">How is it most appropriate to contact you? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"best-contact\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"best-contact\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"best-contact\" \/><\/span>\n<\/p>\n<h3>5. Relationships\n<\/h3>\n<div class=\"form-cols\">\n\t<p><label for=\"marriage-date\">If married, date of marriage<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marriage-date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"marriage-date\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"marriage-date\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"living-together-date\">Date when you started living together<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"living-together-date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"living-together-date\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"living-together-date\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"separation-date\">If separated, date of separation<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"separation-date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"separation-date\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"separation-date\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"nisi-date\">If divorced, date of conditional<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nisi-date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"nisi-date\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"nisi-date\" \/><\/span>\n\t<\/p>\n\t<p><label for=\"absolute-date\">If divorced, date of final order<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"absolute-date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"absolute-date\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"absolute-date\" \/><\/span>\n\t<\/p>\n<\/div>\n<p><label>Are you seeking? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"status-seeking\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"status-seeking\" value=\"Permanent separation\" \/><span class=\"wpcf7-list-item-label\">Permanent separation<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"status-seeking\" value=\"Divorce\" \/><span class=\"wpcf7-list-item-label\">Divorce<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Do you think your partner\/former partner wants? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"partner-wants\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"partner-wants\" value=\"Permanent separation\" \/><span class=\"wpcf7-list-item-label\">Permanent separation<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"partner-wants\" value=\"Divorce\" \/><span class=\"wpcf7-list-item-label\">Divorce<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Have you made attempts at reconciliation? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reconcile-attempt\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"reconcile-attempt\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"reconcile-attempt\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"married-previously\">If either of you was married previously, please give brief details<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"married-previously\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"married-previously\" aria-invalid=\"false\" name=\"married-previously\"><\/textarea><\/span>\n<\/p>\n<p><label>Have you remarried? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"remarried\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"remarried\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"remarried\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Are you cohabiting? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cohabiting\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"cohabiting\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"cohabiting\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><strong style=\"text-decoration:underline\">IMPORTANT:<\/strong>\n<\/p>\n<p><label>Are there any issues of protection, violence or safety which we may need to address?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"issue-protection\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"issue-protection\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"issue-protection\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"issue-protection\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Would you like further information on this?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"issue-info\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"issue-info\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"issue-info\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"issue-info\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Normally mediation takes place with both of you in the room at the same time. Are there any reasons why you would wish to start the first session separately?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"issue-room\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"issue-room\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"issue-room\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"issue-room\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h3>6. Children and other Dependants\n<\/h3>\n<div data-wpcf7-group-id=\"dependants\" class=\"wpcf7-field-groups \">\n\t<div class=\"wpcf7-field-group\">\n\t\t<div class=\"form-cols\">\n\t\t\t<p><label>Name<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dep-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dep-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label>Date of Birth<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dep-dob\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yyyy\" value=\"\" type=\"text\" name=\"dep-dob\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><label>Gender<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"deb-gender\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"deb-gender\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"deb-gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"form-cols\">\n\t\t\t<p><label>Place of education<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dep-edu\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dep-edu\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label>Any special needs?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dep-needs\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dep-needs\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><button type='button' class='wpcf7-field-group-remove '>-<\/button><button type='button' class='wpcf7-field-group-add '>+<\/button><input type=\"hidden\" class=\"wpcf7-field-group-count\" name=\"_wpcf7_groups_count[dependants]\" value=\"1\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label for=\"child-living\">With whom are the children living?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"child-living\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"child-living\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"child-living\" \/><\/span>\n<\/p>\n<p><label for=\"dep-arrangements\">Please outline the current arrangements for the children<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dep-arrangements\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"dep-arrangements\" aria-invalid=\"false\" name=\"dep-arrangements\"><\/textarea><\/span>\n<\/p>\n<p><label for=\"children-in-contact\">If you are separated from the other parent, are the children in contact with both parents, or with any other persons?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"children-in-contact\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"children-in-contact\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"children-in-contact\" \/><\/span>\n<\/p>\n<p><label for=\"children-aware\">To what extent are the children aware of the situation between you?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"children-aware\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"children-aware\" aria-invalid=\"false\" name=\"children-aware\"><\/textarea><\/span>\n<\/p>\n<p><label for=\"fin-support\">What are the arrangements for financial support in relation to any of the children?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fin-support\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"fin-support\" aria-invalid=\"false\" name=\"fin-support\"><\/textarea><\/span>\n<\/p>\n<p><label>Child Support Agency involved?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"csa-involved\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"csa-involved\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"csa-involved\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"csa-involved\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Child Support Agency Assessment made?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"csa-assesment\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"csa-assesment\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"csa-assesment\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"csa-assesment\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Court order for maintenance?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"court-order\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"court-order\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"court-order\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"court-order\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Voluntary maintenance arrangement?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"vol-maint\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"vol-maint\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"vol-maint\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"vol-maint\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"other-fin-support\">Other?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-fin-support\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"other-fin-support\" aria-invalid=\"false\" name=\"other-fin-support\"><\/textarea><\/span>\n<\/p>\n<p><label>Is financial support in relation to any of the children actually being paid?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fin-support-paid\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"fin-support-paid\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"fin-support-paid\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"fin-support-paid\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"child-pay-freq\">If so, how much and how often?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"child-pay-freq\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"child-pay-freq\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"child-pay-freq\" \/><\/span>\n<\/p>\n<p><label>Do you have parental responsibility for your children?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"parental-res\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"parental-res\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"parental-res\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"parental-res\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Is this an issue between you and your partner\/former partner?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fin-support-issue\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"fin-support-issue\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"fin-support-issue\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"fin-support-issue\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h3>7. Preliminary Financial Outline\n<\/h3>\n<p><i>If financial matters are to be considered, a more detailed questionnaire will be supplied.<\/i>\n<\/p>\n<p><strong style=\"text-decoration:underline\">Property<\/strong>\n<\/p>\n<div data-wpcf7-group-id=\"property\" class=\"wpcf7-field-groups \">\n\t<div class=\"wpcf7-field-group\">\n\t\t<p><label>Address<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-home\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"family-home\"><\/textarea><\/span>\n\t\t<\/p>\n\t\t<p><label>Is this property?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"property-type\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"property-type\" value=\"Rented\" \/><span class=\"wpcf7-list-item-label\">Rented<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"property-type\" value=\"Owned\" \/><span class=\"wpcf7-list-item-label\">Owned<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label>Is the above?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"property-nature\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"property-nature\" value=\"\u206dJointly\" \/><span class=\"wpcf7-list-item-label\">\u206dJointly<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"property-nature\" value=\"Solely\" \/><span class=\"wpcf7-list-item-label\">Solely<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"form-cols\">\n\t\t\t<p><label>If solely, by whom?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"solely-by\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"solely-by\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p><label>Estimated current value<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"property-val\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"property-val\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><label>Present estimated mortgage balance<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"property-bal\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"property-bal\" \/><\/span>\n\t\t<\/p>\n\t\t<p><button type='button' class='wpcf7-field-group-remove '>-<\/button><button type='button' class='wpcf7-field-group-add '>+<\/button><input type=\"hidden\" class=\"wpcf7-field-group-count\" name=\"_wpcf7_groups_count[property]\" value=\"1\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><strong style=\"text-decoration:underline\">Employment<\/strong>\n<\/p>\n<p><label for=\"occupation\">What is your occupation? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"occupation\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span>\n<\/p>\n<p><label for=\"gross-salary\">Current gross salary or earnings from work (please bring documentary confirmation with you to your first appointment with a mediator) <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gross-salary\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"gross-salary\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"gross-salary\" \/><\/span>\n<\/p>\n<p><label>Do you have any other sources of income? <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-income\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"other-income\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"other-income\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"other-earnings\">If yes, please provide details and amount<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-earnings\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"other-earnings\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-earnings\" \/><\/span>\n<\/p>\n<h3>8. Outline of issues you want to resolve\n<\/h3>\n<p><label>Property and Finance <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"extra-prop\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"extra-prop\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"extra-prop\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"extra-prop\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Children <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"extra-children\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"extra-children\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"extra-children\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"extra-children\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Relationship Breakdown Issues <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"extra-rel\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"extra-rel\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"extra-rel\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"extra-rel\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Divorce and\/or Separation <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"extra-divorce\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"extra-divorce\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"extra-divorce\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"extra-divorce\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Emotional\/Communications issues <span class=\"u-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"extra-comm\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"extra-comm\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"extra-comm\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"extra-comm\" value=\"Not sure\" \/><span class=\"wpcf7-list-item-label\">Not sure<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label for=\"extra-other\">Other?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"extra-other\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"extra-other\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"extra-other\" \/><\/span>\n<\/p>\n<h3>9. Your reasons for coming to mediation\n<\/h3>\n<p><label for=\"reasons-for\">Please indicate what issues you feel need to be considered and what your aims are in coming to mediation. We appreciate that you may need to know more from the mediator\/s, but it would help to have some preliminary idea of what you hope to achieve. Please do not provide or send copies of correspondence that cannot be mentioned in joint discussions with you both. Mediators cannot receive information that is confidential to one of you (except a private address or telephone number you want to keep confidential from a partner\/former partner)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reasons-for\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"reasons-for\" aria-invalid=\"false\" name=\"reasons-for\"><\/textarea><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p>&nbsp;<\/p>\n<p>Becket Chambers takes the protection of your personal information very seriously. All information you supply to us within this referral form is only shared with those members of staff and administration who need to have it to work on your case.<\/p>\n<p>Once you become a client, this form will become part of your file and will be kept both in a file and electronically with your case papers. These will be destroyed once your case is closed in accordance with our Retention Policy.<\/p>\n<p>If you do not become a client, this form will be destroyed in accordance with out Retention Policy.<\/p>\n<p>If you have any concerns about the safety of your personal information, please see a copy of our Privacy Notice, both on-line or by request from the Chambers.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; Becket Chambers takes the protection of your personal information very seriously. All information you supply to us within this referral form is only shared with those members of staff and administration who need to have it to work on your case. Once you become a client, this form will become part of your file [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":19,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Family Mediation Referral - Becket Mediation<\/title>\n<meta name=\"description\" content=\"You can resolve all types of family disputes with family mediation. 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