MEDIATION CENTRE FEEDBACK FORM (It is important that we evaluate the mediation that you have taken part in to ensure that our mediators are providing the best service possible. All responses are treated in confidence) Full Names Mediators Name Date of Mediation Please answer the following questions by ticking the box that most accurately reflects how you feel. 1. Were the initial arrangements for the mediation satisfactory? Were you given some guidance about preparing for the mediation? Response YesBrieflyUnsureNot at all Further Comments 2) Did the mediator adequately explain the mediation procedure at the initial joint meeting or privately Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree 3) The mediation information given to me by the mediator was clear and easy to understand Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 4) The mediator was fair and impartial? He / she was a good listener developing good rapport with you/the client? His / her interventions were helpful? Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 5) I felt comfortable that confidentiality was respected at all times Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 6) The mediator….(please tick any of the boxes that you agree with, and /or provide feedback below) Rate Was impartialMade me feel relaxed and comfortableHelped us to identify and consider a number of constructive optionsListened to us carefullyRemained calm and professional Further Comments 7) Following mediation my understanding of the other person has improved Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 8. I feel I was given enough support to express my views Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 9) From my point of view, the situation has improved following mediation Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 10) I feel more able to deal with any differences that might arise in future with the same or a different party Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 11) I would recommend the mediation service to a colleague Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree 12) What would have improved the mediation service / experience for you? Further Comments 13) Overall, I would rate the mediation service as effective Rate Strongly AgreeAgreeUnsureDisagreeStrongly Disagree Further Comments 14) Any additional comments you would like to make Further Comments Please leave this field empty.