Lakeside Mediation Center - Dedicated to the peaceful, constructive and efficient resolution of disputes.

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Name of Mediator
Date of Mediation

Please express your agreement or disagreement with each of the following statements. Click in the circle of the number that best represents your opinion. The categories are: (1) Strongly Disagree (SD) (2) Disagree (3) Neither Agree nor Disagree (4) Agree (5) Strongly Agree (SA)
I received an explanation about the mediation prior to attending the scheduled session.	1 2 3 4 5
The mediation was scheduled promptly	1 2 3 4 5
After the mediator’s introduction at the mediation session, I felt that I understood the mediation process.	1 2 3 4 5
I had an opportunity to present my views during the mediation process.	1 2 3 4 5
The mediator listened and helped clarify parties’ concerns and interests.	1 2 3 4 5
The mediator seemed to understand the concerns and interests of the parties.	1 2 3 4 5
The mediator remained neutral during the session	1 2 3 4 5
The mediator helped the parties develop options for resolving the situation.	1 2 3 4 5
The options developed during the mediation were realistic solutions to resolving the situation	1 2 3 4 5
I was satisfied with the fairness of the mediation process.	1 2 3 4 5
If mediation did not resolve the claim, I believe that progress was made toward resolution.	1 2 3 4 5
Please check the appropriate answer about the status of your mediation session.	Mediation is completed and the situation has been resolved in mediation. Mediation is completed, but the situation has not been resolved and the parties will not mediate again. Mediation is still ongoing and the parties will meet on another date.
Would you be willing to participate in another mediation of this same situation in the future?	Yes No
If mediation did not resolve the situation, why do you believe that mediation was unsuccessful?
Is there anything else that the LAKESIDE MEDIATION CENTER should know about this mediation, this mediator, or the mediation process?
May we use your comments in a published testimonial? If so, please let us know how to contact you.	Yes No Contact Info: