CJP Referral Form

Mediation 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. Please complete this form and Fax: (540) 347-4689 or email: pdrc@verizon.net it to PDRC. If you have a general question, please call PDRC at 540-347-6650.