The Alternative Dispute Resolution Resource Serving Private Individuals, Attorneys, Business And The Insurance Community

Instructions: To submit a case to MDRS you can call us and submit case information by telephone to one of our Case Administrators, OR you can complete the electronic form below and email it to us.

Upon receipt, we will contact you to finalize the case submission, answer any questions you may have, and MDRS will do all that is necessary thereafter to contact all parties and schedule the matter for a convenient mediation session or arbitration hearing.

MDRS CASE SUBMISSION
Date:
Submitted By:
Case Name:
VS.
  
Type of Case:
Email Address:
 
PLAINTIFF INFORMATION:
DEFENDANT INFORMATION:
# of Witnesses
# of Witnesses
Name:
Name:
Name:
Name:
Plantiff Attorney:
Defendant Attorney:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Insurance Co:
Insurance Co:
 
ADDITIONAL PARTIES:
Name:
 Plantiff: Defendant:
Attorney/Rep:
  
Address:
  
Phone:
Fax:
Insurance Company:
  
Claim Number:
    
Services Requested:
 Mediation Agreement: Arbitration Agreement: High-Low Arbitration: Confidential High Low Arbitration Agreement: Case Submission:
Other, please specify:
  
STATUS OF NEGOTIATIONS: (OPTIONAL DISCLOSURE):
Is liability stipulated?
Most recent demand:
Most recent offer:
Additional comments:
  
Estimated length of Hearing:  
Preferred dates & location:  
Preferred Neutral(s):
  
Please list any further comments below or on a separate sheet: