Bexar County Forms

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Dispute Resolution Center Mediation Request Form

  1. Dispute Resolution Center

  2. Mediation Request Instructions

    1. Fill out the Mediation Request Form completely. The addresses given should be mailing addresses: business addresses for a business dispute, and home (not work) address for a dispute with a private individual.

    2. Please fill out the "Information About Yourself" section as it relates to you.

    3. Please read the "Waiver and Consent" section completely. BCDRC personnel will review this document with you during the intake interview.

    4. If you are requesting mediation regarding court-ordered child visitation or non-payment of children's medical expenses, you must provide a copy of the court order (Divorce Decree or Suit Effecting a Parent/Child Relationship) to the BCDRC. No mediation will be scheduled until we receive a copy of the applicable court order. Please send only a photocopy of the document. We do not need the original or any supporting documentation. If there is no court order, please indicate that on your request.

  3. Scheduling

    Mediation are typically scheduled at 6:00 p.m. (Central Time), Monday through Thursday. We also schedule daytime mediations Monday through Friday, if necessary. If you are unavailable particular days or times, please advise us when we interview you.

  4. Your Information:

  5. Other Party's Information:

  6. Please Tell Us About The Incident:

  7. Did the incident happen in Bexar County?*

    Please Note: We only handle cases within Bexar County.

  8. Please limit your explanation to 1,000 characters.

  9. Is there any legal action pending in this matter?*

    "Legal action pending" means a court case has been filed in which a judge has not yet made a final decision.

  10. Does this dispute involve child visitation or medical expenses?*

  11. If a court order has been finalized, please upload the order.

  12. Information About Yourself

    Please provide the following information about yourself. Please Note: The following fields are required.

  13. Please type the number of people in your household.

  14. Waiver and Consent Form

    This waiver and content form is executed in exchange for participation by the mediator in the mediation of a dispute between the above named individuals. It pertains only to the matters arising during mediation of that dispute.

    1. I understand that the mediator is not a legal advisor and is not to provide legal advice to any party involved in mediation. I agree to hold the said mediator harmless of any observations, suggestions or implications that he/she may make in the course or mediation. I specifically agree to obtain legal advice on any issue of interest to me from my own attorney and not to rely upon the mediator for such advice. By checking the appropriate box above, I acknowledge that there is or is not legal action pending that relates to matters involved in mediation. "Legal action pending" means a court case has been filed in which a judge has not yet made a final decision.

    2. I waive any right of action that I may have against the mediator for any allegation of wrongful conduct on his/her part or on the part of Dispute Resolution Center employees, while acting in the course of the mediation herein agreed to.

    3. I agree to the necessity that mediation be confidential and, therefore, agree that I will not call the mediators or Dispute Resolution Center employees who serve on my case to act as witnesses in any court of competent jurisdiction to testify to facts concerning or relating to the subject matter being medicated, and that I will not subpoena documents or information about my case which may have been retained in any case file. I understand that no subpoenas, citations, writs or any other process shall be served at or near the location of any mediation session. I further agree that I will not utilize any voice recording device during the mediation session.

    4. I agree treat anything said by opposing party as part of an offer to compromise and settle the dispute being mediated. I further agree that statements made during mediation shall be treated as offers to settle and shall not be admissible should this matter become a matter in litigation.

  15. Texas law requires the reporting of abuse or neglect of children, the elderly and the disabled. Should such information surface during mediation, it will be reported to the proper authorities as will any serious threats of imminent danger or physical harm.

  16. Is litigation pending?*

  17. By typing my name in the above field, I consent to these terms and waive the rights herein specified, and I know that I have the right to consult legal counsel before executing this document.

  18. Leave This Blank:

  19. This field is not part of the form submission.