New Case Intake Form

3610 American River Drive, #112 Sacramento, CA 95864 Phone: 916.483.2222 lewis@mediatorjudge.com

Judge Darrel W. Lewis (Ret.)

Mediator

3610 AMERICAN RIVER DRIVE, SUITE 112
SACRAMENTO, CA. 95864-5999
-An experienced judge - - A successful mediator-

JUDGE DARREL W. LEWIS

~ NEW CASE INTAKE FORM ~

You may complete and email the form below

you may click here to download a printable copy to complete by hand and fax to me.

Today’s Date:

Case Name: (primary names are sufficient)

Subject matter of case:

Type of Proceeding:

Mediation
Discovery dispute
Other

Date of Proceeding:

Day of Week of Proceeding:

Start Time:

Duration:

Estimated Total Number of People Attending:

LOCATION OF PROCEEDINGS I prefer my facility, but I will gladly travel elsewhere if you enter the full address below:

Alternate Location:

COORDINATING ATTORNEY

Coordinating Attorney Name and Address:

Coordinating Attorney Phone:

Coordinating Attorney Fax:

Coordinating Attorney Email:

SECOND ATTORNEY

Second Attorney Name and Address:

Second Attorney Phone:

Second Attorney Fax:

Second Attorney Email:

THIRD ATTORNEY

Third Attorney Name and Address:

Third Attorney Phone:

Third Attorney Fax:

Third Attorney Email:

ADDITIONAL ATTORNEYS Insert below, all information as you did above, for each additional attorney:

ADDITIONAL ATTORNEYS

Additional Comments:

Note: Please do not include any URLs in form.

www.MediatorJudge.com

Telephone: (916) 483-2222 Facsimile: (916) 483-0422

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