Superior Court of the District of Columbla MEDIATION SURVEY FORM TO BE COMPLETED BY PARTY Please fill out this form promptly after the mediation conference and return it to the Multi-Door Division case manager N a m e o f mediator:* D a t e mediator of Conf. Case Name: Are you the: I plaintiff insurance defendant Did an attorney represent you in this case? If not, did you have any difficulty representing yourself? Did you reach an agreement and settle your case today? 0 0 0 yes yes yes representative On0 On0 On0 Please circle the number which best reflects how you feel about the following statements. 2-Disagree 1 . The mediator explained the mediation process clearly so that I knew what to expect during the mediation session. 3-Not Sure 4 ge - re A 5--ngtY&- ` 2. The mediator allowed me and/or my attorney to fully present my case. 3. The mediator carefully listened to my side of the case. 4. The mediator asked appropriate questions to better understand the facts in the case. 5. The mediator helped me consider different options for settling the case. 6. The mediator treated all parties 7. fairly. Overall, I was satisfied with the mediation session and the way the mediator handled it. Please add any comments you wish to make regarding the mediator or the mediation process on the the back back of this form. Thank you. 2001 © American LegalNet, Inc.