CJP Referral Form for Community Services

Mediation and Restorative Justice Referral Form (click here to view/download)

This form is to be used by organizations and individuals wishing to refer a conflict to mediation services provided by PDRC. To make a referral, check with at least one of the participants to make sure they want the case to go to mediation. If both parties do not agree to mediation conflict coaching is available to individuals. Please complete this form and submit below. The form may also be sent via Fax: (540) 347-4689 or email: pdrc@verizon.net to PDRC. If you have a general question, please call PDRC at 540-347-6650.