Request for mediation (self referral)

Use this form to request a self referral for mediation if you are a home owner or a private rented tenant, if you are a tenant of a Registered Social Landlord (RSL) then please contact your Housing Association. 

If, to your knowledge the dispute involves:

  • severe drug or alcohol dependency;
  • severe mental health problems;
  • actual or threatened violence between the parties;
  • any current legal proceedings (e.g. injunctions, ASB orders, ABC contracts, etc.), police involvement or known criminal activity; and or
  • any party having significant criminal history.

then it is possible that mediation might not be appropriate, email your details and we will contact you to discuss if mediation is the right course of action 

Each application can have up to four different households (parties) which would be classed as one case, five to eight households (parties) would be classed as two cases therefore two separate applications would have to be made. 

Using this form

When you go through the form, you have about 20 minutes to complete each page. Don't use your normal 'Back' button to return to an earlier question, but use the 'Previous' button on the page you are on. Questions marked * can't be left blank.