Apply Online Form

Please fill out the form to apply for our mediation services.

You will also be required to complete and return a signed copy of our confidentiality form found below.

Confidentiality Form

For all inquiries, please email admin@kpconsult.com.au

Name (Formal)

First Name

Last Name

Preferred Name

Email Address

Phone Number

Address

Suburb

Postcode

Name of Ex Partner

First Name

Last Name

Do you and your partner have children?

What is your reason for doing mediation?

Are you aware of the fees charged for mediation at KP Consult?

For further information please refer to our website for up to date prices

How did you hear about KP Consult?

I agree to the terms and conditions

We recommend you read the terms and conditions in full before applying for our mediation service. By ticking this box you are agreeing to the pricing, confidentiality and privacy agreements.

Apply Online Form

Your Mediation Expert