Danielson Mediation and Arbitration logo

At any time, you may contact our office to schedule a mediation or arbitration. We can be reached at (479) 387-5544.

If you would rather submit information online for scheduling, please complete the following as thoroughly as possible. Upon receipt, our office will contact you to schedule the mediation.

A MEDIATION OR ARBITRATION IS NOT CONSIDERED BOOKED UNTIL YOU HAVE RECEIVED VERBAL CONFIRMATION FROM OUR OFFICE FOR A SET DATE AND TIME.

Civil Mediation

Mediation requested by:
Phone number:
eMail address:
Preferred mediation dates:
Requested location:
Is this currently in suit?:
What is the full style of the case?:
Number of parties involved?:
Plaintiff's Attorney:
Firm name:
Address:
Phone number:
eMail address:
Defendant's Attorney:
Firm name:
Address:
Phone number:
Fax number:
eMail address:
Insurance Carrier:
Address:
Phone number:
Fax number:
Claim representative:
Claim rep's eMail:
Attending in person?
Claim number:
Co-Defendant's Attorney:
Firm name:
Address:
Phone number:
Fax number:
eMail Address:
Other parties/attorneys involved:
Description of case:
Is this a court ordered mediation?:
Who will pay the cost of the session?
Comments:

 

DAVID A. DANIELSON
Attorney at Law - Mediation & Arbitration
4491 W. Sandingham St.
Fayetteville, AR 72704
(479) 387-5544
Email: daviddan@DanielsonMediation.com