Intake Form

Pactum Factum

Negotiation and Dispute Resolution

This is a confidential and secure tool for information and self-assessment, not for the mediator’s judgment. Success in mediation is dependent upon preparation. Your answers inform whether the mediation process can fulfill your needs. If a victory is absolutely required you might consider proceeding with litigation.

The process of coming up with answers to these questions may stimulate new avenues of thought. Taking the time to reflect on your answers to these questions may help you see why you are on this particular path.

Please be completely honest – there are no right or wrong answers, and you are not being judged in any way. 


Personal Information


Are you represented by an attorney?

Do you and the other party differ in your current interpretations the problem?

Did you discuss your feelings with the other party?

On a scale of 1-5 (with 5 being very important and 1 being not at all important), please rate the importance of the following statements: a) I want an immediate solution even if it is less than I would like

b) I want a big win even if I have to wait a few years

c) I want financial satisfaction

d) I want emotional satisfaction

e) I want to preserve peace in the relationship

f) I want to get even

Do you have a private space where you can have an online meeting without anyone else hearing or watching you?

Do you have your own computer that is private, password-protected, has a camera and a microphone (if not, mobile phone can be used)?

Do you need the assistance of anyone else in the room with you while you participate in your mediation online?

Have you participated in mediation before?

Have you used Zoom before?


447 Sutter St, Ste 405
San Francisco, CA 94108

Call Us

1 (925) 322-0545