Feedback Request Form

This Feedback Request will take just a few minutes to complete.

Every IMI Certified Professional Mediator has attained a high standard of professional competency in the practice of mediation. On completion of each mediation, the Mediator will invite the participants to complete this Feedback Request Form.

Your feedback will:

  • Help future users to have more information about working with this Mediator
  • Provide the Mediator with an opportunity to know your perception of the mediation process on this occasion, how effective (s)he was, and why, and
  • Enable the Mediator’s Peer Reviewer to prepare the Mediator’s Feedback Digest, which is a professional requirement of all IMI Certified Mediators, in line with the IMI Feedback Digest Guidelines for Reviewers.

You may complete this Feedback Request Form in handwritten form or fill in electronic form and send it to the Mediator’s Reviewer (the mediator should provide you with an address for the Reviewer) or to the Mediator direct for forwarding to the Reviewer. The Mediator will express a preference. As the Feedback Digest is prepared by the Mediator’s Reviewer, it should contain an objective and independent summary of the content of previously-submitted forms. The Feedback Digest may be relied upon by other parties in the future in deciding whether to appoint this Mediator, so please try to be fair and helpful as possible in providing your comments. Please try not to be influenced unduly by the outcome of your mediation but to focus on the Mediator him/herself and on any particular contributions that (s)he may have made that you found to be especially important.

You are welcome to see an example of Feedback completed by a Party in an actual case.

The Mediator’s task is a challenging one. In your responses, please try to appreciate this and to be specific and constructive as possible.  It would be helpful if you could include your name and details on the last page so that you can be contacted by the Reviewer in the unlikely event that clarification is needed.  Please be assured that your information, and any information about the mediation, will remain confidential and will not be provided to third parties.

The feedback request form is available in the following languages:

Title Version Description Download
English Feedback Form (pdf) IMI Mediator Feedback Request Form (English) Download Preview
English Feedback Form (doc) IMI Feedback Request Form (English) Download Preview
Dutch Feedback Formulier IMI Feedback Request Form (Dutch) Download Preview
French Feedback Form IMI Feedback Request Form (French) Download Preview
German Feedback Formular (Deutsch) IMI Feedback Formular (Deutsch) Download Preview
Portuguese Formul rio de Solicita o de Comenta rios IMI Feedback Request Form (Portuguese) Download Preview
Russian Feedback Form (Русский) IMI Mediator Feedback Request Form (Russian) Download Preview