Mediation Evaluation Survey

Please take a few minutes to complete our survey. You can either download it and then mail or fax the completed form to us or you can complete our online survey form below.

The results will be used to document the effectiveness of family law mediation in Polk County. Participating in this study may provide you with a sense that you have contributed to increasing the understanding of and improving the process of divorce and family mediation services. Your participation is strictly voluntary and you are free to decline. Efforts to protect your confidentiality will be maintained.

Please take a few minutes to complete this survey. The results will be used to document the effectiveness of family law mediation in Polk County. Participating in this study may provide you with a sense that you have contributed to increasing the understanding of and improving the process of divorce and family mediation services. Your participation is strictly voluntary and you are free to decline. Efforts to protect your confidentiality will be maintained..

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Name: *

Email: *

Your mediation was

Court Ordered
Suggested By Your Attorney
Your Preference
Other Referral

What types of issues did you mediate?

Issues pertaining to a temporary order before the final decree
Issues pertaining to the final decree
Issues involving modification of an existing order or decree
Issues involving a contempt of court action

How soon before a hearing or trial did you participate in mediation?

A matter of days
A matter of weeks
A matter of months

How many mediation sessions did you attend?

How many total hours?

Considering the number of issues to be discussed in mediation how many were addressed?

None
Some
All

Of the issues discussed on how many were you able to reach an agreement on?

None
Some
All

Which issues did you mediate?

Parenting schedule: custody/visitation
Child support
Alimony/spousal support
Financial issues i.e. assets/debts
Non-compliance with a previous decree
Other

Do you have a lawyer?

Yes
No

If you do have a lawyer did you talk with him/her (please check all that apply):

Before the first session
During the session
After the agreement was drafted
Not at all

If you didn’t talk with your attorney, why not?

Would you recommend mediation to others?

Yes
No

Why or why not?

I felt pressure, coercion, or concern for my physical safety or threats from the other party:

before the mediation session
during the mediation session
after the mediation session
never

If yes, please explain:

If you reached agreements in mediation, do you feel they are generally fair?

Yes
No
Uncertain

Did your lawyer, mediator or mediation staff person speak with you before the mediation session regarding domestic violence or other matters that may have prevented you from feeling safe in mediation?

Yes
No
Uncertain

Please agree or disagree with the following statements. (Choose SA for strongly agree, A for agree, D for disagree, SD for strongly disagree and DK/N for don’t know or neither.)

I was willing to come to the mediation session.

SA
A
D
SD
DK/N

Before we went to mediation, I was optimistic that mediation would result in a satisfactory solution..

SA
A
D
SD
DK/N

The mediation process was adequately explained to me.

SA
A
D
SD
DK/N

Preparing for mediation was adequately explained to me.

SA
A
D
SD
DK/N

My attorney adequately prepared me for mediation.

SA
A
D
SD
DK/N

The mediator did not take sides.

SA
A
D
SD
DK/N

The mediator allowed both sides to express their views.

SA
A
D
SD
DK/N

The mediator did not allow one person to control the discussion.

SA
A
D
SD
DK/N

The mediator asked questions to make sure we both thought the agreement was realistic and fair.

SA
A
D
SD
DK/N

I was able to express my opinions in mediation.

SA
A
D
SD
DK/N

I am satisfied with our mediator.

SA
A
D
SD
DK/N

I am satisfied with mediation.

SA
A
D
SD
DK/N

Did the mediator recommend a particular outcome?.

Yes
No

What was your share of the total fee?

In your opinion, this amount was:

too much
about right
less than expected

Did you benefit from mediation?

Yes
No

You are:

Male
Female

Length of marriage/relationship

Number and age(s) of children

Your age:

Ethnicity:

Education (highest grade level achieved):

Your income:

$0-$10,000
$10,001-$25,000
$25,001-$50,000
$50,001- $75,000+

Name of your mediator:

Mediators learn from feedback. Would you be willing for your mediator to receive a copy of this evaluation?

Yes
No

Your Name:

Other Comments:

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