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Self-referred mediation request form
Fill out the self-referred mediation form to request a custody or parenting time mediation appointment with Family Court Services.
Both parties must request and agree to the mediation
At least one party must live in Hennepin County
Family Court Services cannot provide services when there is an active court order restricting one person’s contact with the other, unless the order allows for mediation services
Click "Submit" to complete your self-referred mediation request. A confirmation screen will appear on the next page. If you do not receive the confirmation message, call 612-348-3754 for assistance.