Intake Form

Conflict Resolution Service Inquiry

(* is required information)

Briefly explain the conflict or issue you are having that prompted you to contact us.
If you selected 1) Mediation or 2) Facilitation or 3) Negotiation Assistance above, please provide additional information on the other parties you are dealing with. (Mark All that Apply)
Please provide information on the parties referred to above. We will follow up with you to get more details to determine if we need to contact them.
Has the Conflict Escalated to Physical Violence?
  
Have you had issues with the other party in the past? (Please Explain Briefly)
If you could settle this conflict what would be your desired outcome? (Briefly Explain)
Please provide 3 or 4 upcoming dates and times when you would be available to be contacted to work more on these issues.
How did you find out about us? Was it perhaps via a referral, via the website, a suggestion from the court, a flyer, or something else?
What method of contact is best for you?




It is our pledge that a member of the ESCRO team will attempt to contact you within 48 hours. Please note that ESCRO will only attempt to contact you 3 times using your preferred contact method. Thank you for your trust and we look forward to speaking with you.