Superior Court of California, County of Los Angeles

FAMILY COURT SERVICES

CONFIDENTIAL MEDIATION FORM

Your matter has been scheduled for a Mediation Appointment.

Mediation is an opportunity before your court hearing to agree to a schedule that works best for parents to share time with the child(ren). This process involves you and the other parent working with a mediator. However, you may attempt to conduct the negotiation of the time each parent will share with the child(ren) online without the assistance of a mediator using this link: https://losangelescafam.modria.com/.

If you prefer to work with a mediator in reaching this agreement or are unable to reach an agreement using the online program, you must participate in the mediation appointment already scheduled for you with a court mediator from Family Court Services. To meet with a court mediator, you must confirm your appointment by submitting this form online on the next page, by clicking the “continue” button below, (5) days before the scheduled appointment time.

Complete as much information as possible on this form. This form must be completed by each parent and submitted to the Court prior to Mediation. All files and records involving your mediation are confidential, including this form, except when a mandated report is necessary for example when there is suspected child abuse or threats to harm yourself or others.