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Mediator Party Evaluation
This form has been modified since it was saved. Please review all fields before submitting.
To help us to maintain the quality of the mediation program, please answer all of the questions below. Your responses will be kept confidential and will be used to evaluate our services. No identifying information about you will be released.
Case Name
Case Number
Mediator Name
Date of Mediation
Date of Mediation
What is your relationship to the child(ren)?
Parent
Other
If Other, please specify
The following questions ask about your experience during the mediation session. Please check one box for each question.
How clearly did the mediator explain what would happen in mediation?
Not at all clearly
Somewhat clearly
Very clearly
The mediator didn't explain what would happen
Were you able to talk about the issues and concerns that were most important to you?
I was able to talk about none of the issues and concerns that were most important to me.
I was able to talk about some of the issues and concerns that were most important to me.
I was able to talk about most of the issues and concerns that were most important to me.
I was able to talk about all of the issues and concerns that were most important to me.
Did you have the opportunity to express your feelings in mediation?
Not at all
Somewhat
Very much
Did the mediator keep you focused on what was best for the children?
Not at all
Somewhat
Very much
Do you understand the other parent’s point of view better than you did before mediation?
Not at all better
Somewhat better
Much better
How much did the mediation help you to think about different ways to work with the other parent?
Not at all
Some
A lot
Was the mediator active enough in helping you to work out the issues in the dispute?
No
Yes
How well did the mediator understand what was important to you?
Not at all
Somewhat
Very well
Did the mediator treat you with respect?
Not at all
Somewhat
Very much
Did the mediator treat you fairly?
Not at all
Somewhat
Very much
Did the mediator push too hard to get you to settle?
Yes, the mediator pushed too hard
No, the mediator did not push too hard
What was the outcome of the mediation?
We reached agreement on all the issues in the case
We reached agreement on some of the issues in the case
We didn’t reach agreement on any issues in the case
If you reached agreement, please answer the following questions:
Are you clear about the details of the agreement?
Not at all
Somewhat
Very much
Do you have any doubts that the agreement will work?
Not at all
Somewhat
Very much
How satisfied are you with the outcome of the mediation?
Very Unsatisfied
Unsatisfied
Satisfied
Very Satisfied
Regardless of the outcome, how satisfied are you with your overall experience in the mediation session(s)?
Very Unsatisfied
Unsatisfied
Satisfied
Very Satisfied
Would you use mediation again?
Yes
No
Possibly
Why or Why Not?
Please let us know more about your experience:
Things I liked about the mediation:
Things I didn't like about the mediation:
Please help keep us informed about mediation services by answering the following questions about yourself. Your answers will remain completely confidential.
Zip Code
What languages do you usually speak at home?
Age Range
18 - 24
25 - 44
45 - 64
65+
Gender
Male
Female
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