Schedule A Mediation With Joe Knittig - Eischens Mediation Services

Tell us about the matter, the parties, and select 3 dates when you are available. (The starred information is required.) Starting times will be 9:30 am unless otherwise requested.
Case Name*

(and Case Number, if known)
First Requested Date of Mediation*
MM slash DD slash YYYY
Alternate Requested Date of Mediation*
MM slash DD slash YYYY
Second Alternate Requested Date of Mediation*
MM slash DD slash YYYY
Location of Mediation*
- Plaintiff's Attorney's Office
- Defendant's Attorney's Office
- All Participants Online (Zoom)
- Some Participants Online (Zoom)
- Neutral Site
- Undecided
Number of Parties*
Type of Case - Please provide a brief summary of your case*
Venue and Judge (if applicable)
Additional Information
Party and Person Completing This Form*
Enter the name person completing this form and the party that they represent
Email address of Party Completing the Form*
Telephone Number of Party Completing the Form*
Party One Information
Full Name Party 1*
Role In The Case Party 1*
Legal Counsel Full Name Party 1*
Legal Counsel Firm Name Party 1*
Counsel Address Party 1*
Street Address Address Line 2 City State ZIP Code
Counsel Phone Party 1*
Counsel Email Party 1*
Additional Emails Party 1
Enter any additional Party One email addresses. Click the + icon below to add more than one email address.
Party Two
Full Name Party 2*
Role In The Case Party 2*
Legal Counsel Full Name Party 2*
Legal Counsel Firm Name Party 2*
Counsel Address Party 2*
Street Address Address Line 2 City State ZIP Code
Counsel Phone Party 2*
Counsel Email Party 2*
Additional Emails Party 2
Enter any additional Party Two email addresses. Click the + icon below to add more than one email address.
Party 3
Full Name Party 3*
Role In The Case Party 3*
Legal Counsel Full Name Party 3*
Legal Counsel Firm Name Party 3*
Counsel Address Party 3*
Street Address Address Line 2 City State ZIP Code
Counsel Phone Party 3*
Counsel Email Party 3*
Additional Emails Party 3
Enter any additional Party Three email addresses. Click the + icon below to add more than one email address.
Party 4
Full Name Party 4*
Role In The Case Party 4*
Legal Counsel Full Name Party 4*
Legal Counsel Firm Name Party 4*
Counsel Address Party 4*
Street Address Address Line 2 City State ZIP Code
Counsel Phone Party 4*
Counsel Email Party 4*
Additional Emails Party 4
Enter any additional Party Four email addresses. Click the + icon below to add more than one email address.
Party 5
Full Name Party 5*
Role In The Case Party 5*
Legal Counsel Full Name Party 5*
Legal Counsel Firm Name Party 5*
Counsel Address Party 5*
Street Address Address Line 2 City State ZIP Code
Counsel Phone Party 5*
Counsel Email Party 5*
Additional Emails Party 5
Enter any additional Party Five email addresses. Click the + icon below to add more than one email address.
Submit Your Mediation Scheduling Request with Joe Knittig
Click "Submit" to send your request for mediation services. You will receive an email following submission of this form to confirm that we have received your request. You will then receive an email confirming your date within 24 hours. If you do not receive a confirmation email, please contact Angie Fisher at angie@jkemediation.com.

Party One Information

Party Two

Party 3

Party 4

Party 5

Submit Your Mediation Scheduling Request with Joe Knittig

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