Is an electronic signature valid?

Yes. Under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA (adopted in most states), electronic signatures are legally effective if they demonstrate intent and the record is retained.

Can a signer revoke consent after signing?

A party may withdraw consent subject to any terms in the agreement; however, withdrawal may not undo conduct already undertaken and could affect scheduling or enforceability of subsequent settlement documents.

Are mediations confidential?

Confidentiality depends on the consent form and state law. Many states protect mediation communications from admissibility; include explicit confidentiality language and any statutory exceptions.

When is notarization required?

Notarization is not typically required for mediation consent forms, but specific jurisdictions or related settlement documents may require notarization or witness attestation.

What if a signer lacks authority?

If an authorized representative signs without authority, the resulting settlement may be voidable; confirm and document settlement authority in the consent form to reduce risk.

How long should the form be retained?

Retention depends on applicable rules: follow IRS (IRC §6501(a)), HIPAA (45 CFR §164.530(j)), and any state-specific requirements; consult counsel for your situation.

Electronic Signature
Templates
Miscellaneous
Mediation Consent Form

Mediation Consent Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

MEDIATION CONSENT FORM

This Mediation Consent Form documents the mutual agreement of the parties to submit the dispute described below to a voluntary mediation process under the terms set forth herein.

Parties

Party A — Full legal name Party A — Address Party B — Full legal name Party B — Address

WHEREAS

WHEREAS, Party A and Party B are involved in a dispute arising out of transactions and interactions described as:

WHEREAS, the parties desire to engage in a confidential, non‑binding mediation conducted by a neutral mediator to attempt to reach a mutually acceptable resolution without resorting to litigation; and

WHEREAS, the parties acknowledge that participation is voluntary, that any settlement will be reduced to a written agreement, and that the mediator will not impose a decision on the parties.

Scope of Mediation

The mediation will address the matters and claims related to the dispute identified above. The parties authorize the mediator to facilitate discussions, propose settlement options, and assist in drafting any settlement agreement. The mediation does not include adjudication, discovery enforcement, or rulings on legal rights except by agreement of the parties.

Detailed scope and procedure (state issues to be mediated, any limitations, and desired outcomes)

Mediation Process and PARTICIPATION

Participation is voluntary. Each party represents that the individual signing below has full authority to bind that party for the purposes of participating in mediation, negotiating in good faith, and signing any settlement reached. Counsel may attend if identified in the fields below.

Party A — Counsel (if any) Party B — Counsel (if any)

The mediator will act as a neutral facilitator and shall not be an advocate for any party. The mediator's observations, evaluations, or recommendations are not binding unless reduced to a written agreement signed by the parties.

Recording of mediation sessions is permitted only with the advance written consent of all parties and the mediator. Consent to audio or video recording: I consent to audio/video recording

CONFIDENTIALITY

All communications, statements, proposals, and materials prepared for or during the mediation are confidential and inadmissible in any judicial or administrative proceeding, except as necessary to enforce a settlement agreement or as otherwise required by law. The parties agree not to subpoena or compel the mediator to testify or produce records related to the mediation.

Confidential information does not include information that is otherwise admissible or discoverable independent of the mediation, nor does it restrict a party from taking actions to preserve rights required by law or court order, provided the party gives notice to the mediator and the other party prior to disclosure.

PAYMENT TERMS

The parties agree to pay the mediator's fees and administrative costs as follows.

Total mediation fee Payment schedule / deposit required Allocation of fees between parties

Fees split equally Fees paid by Party A Fees paid by Party B Other allocation:

Late fee for unpaid amounts

TERM AND TERMINATION

This Consent is effective as of the Start Date and continues until the earlier of (a) a written settlement agreement executed by the parties, (b) a written declaration by the mediator that the mediation is terminated, or (c) the End Date specified below, unless otherwise extended by written agreement of the parties.

Start Date End Date Notice period to withdraw from mediation

AUTHORITY, SETTLEMENT AND EFFECT OF AGREEMENT

Each signatory represents and warrants that they have the authority to enter into this Consent and to participate in negotiations on behalf of the party they represent. Any settlement reached shall be binding only when reduced to a written agreement signed by authorized representatives of all parties.

GOVERNING LAW

This Consent shall be governed by and construed in accordance with the laws of the State selected by the parties. The parties agree that any dispute concerning the enforcement of this Consent or a written settlement shall be resolved in the courts of the chosen jurisdiction.

Governing law jurisdiction (state)

ENTIRE AGREEMENT

This Consent constitutes the entire agreement between the parties with respect to mediation of the identified dispute and supersedes any prior oral or written understandings. Any amendment must be made in writing and signed by all parties.

ACKNOWLEDGMENTS

By signing below, the parties acknowledge that they have read and understand this Mediation Consent Form, that they enter into it freely and voluntarily, and that they accept the mediator's neutral role and the confidentiality provisions set forth herein.

Party A — Printed Name:

By:

Date:

Party B — Printed Name:

By:

Date:

What a Mediation Consent Form Is and When It Applies

A Mediation Consent Form is a written record where parties agree to use mediation to resolve a dispute, acknowledge the mediator's role, and accept terms for confidentiality, scheduling, and fees. It documents who will participate, whether the process is voluntary, and how communications and settlement proposals will be handled. The form also records consent to electronic communications or eSigning when parties choose online execution. Courts, mediation providers, and counsel commonly require a signed consent form before scheduling sessions to confirm informed consent and procedural expectations.

Why a Clear Consent Form Matters for Effective Mediation

A concise Mediation Consent Form reduces misunderstanding, sets confidentiality and scope, clarifies authority to settle, and establishes procedural rules. It protects parties and the mediator by recording voluntary consent and any agreed limitations.

Who Typically Completes a Mediation Consent Form

The form is completed by the parties to the dispute, their attorneys or authorized representatives, and sometimes the mediator to confirm logistical and legal terms.

Party representatives or attorneys sign to confirm authority to negotiate or present settlement options.
Mediators use the form to document confidentiality rules, service parameters, and session logistics.
Court administrators may require a filed copy when mediation occurs under court programs or rules.

Completed consent forms help mediators confirm participation, counsel verify authority, and courts understand whether mediation was voluntary and properly executed.

Who May Sign and Their Roles

Claimant

The individual or entity bringing the claim should sign or have an authorized representative sign, confirming their willingness to mediate and acknowledging any limits on authority to settle.

Respondent

The opposing party or its authorized representative signs to confirm consent to the process, agreement to confidentiality terms, and to identify who may finalize settlement agreements if mediation succeeds.

Core Elements to Include In a Professional Consent Form

A complete Mediation Consent Form clearly identifies parties, mediator, scope, confidentiality, authority to settle, fees, and signature blocks so issues are resolved efficiently and ethically.

Party Identification

Full legal names, business names if applicable, contact information, and representative details to ensure the mediator and other parties can confirm identities and proper service of notices.

Mediator Details

Name, credentials, organization, contact details, and any applicable disclosures about the mediator’s role or potential conflicts of interest to maintain transparency and ethical compliance.

Scope of Mediation

A precise description of the matters to be mediated, whether the process is binding or non-binding, and any topics excluded from mediation to avoid later disputes about coverage.

Confidentiality

Explicit confidentiality terms, exceptions (e.g., court orders or mandatory reporting), and whether mediation communications are admissible in later proceedings under applicable state law.

Authority to Settle

A statement confirming that signatories have the authority to negotiate or stating who may enter into a binding settlement, including any requirement for corporate or insurer approvals.

Fees and Logistics

Allocation of mediator fees, payment terms, scheduling expectations, cancellation policy, and how electronic execution or e-signatures will be handled.

Essential Information Every Form Should Capture

Names: Full legal names

Contact: Street, city, state, ZIP

Representative: Role and firm

Mediator: Name and credentials

Dates: Effective and session dates

Signatures: Signature and date

Step-by-Step: Completing the Mediation Consent Form

Follow these sequential steps to ensure the form is complete, accurate, and ready for in-person or remote sessions.

01

Identify Parties: Enter full names and contact details for all parties and representatives.
02

Describe Scope: Specify the disputes or claims covered by mediation.
03

Confirm Authority: Record whether signers can settle or need approval.
04

Sign and Date: Execute the form by hand or using an eSignature and include execution date.

How to Set Up an Online Mediation Consent Workflow

When using an eSignature platform, configure fields and routing to match the form sequence and authentication needs.

Field	Configuration
Party Name	Required text field; validate non-empty
Signature	Signature field; allow typed or drawn signatures
Effective Date	Date field with MM/DD/YYYY format
Authority Checkbox	Required checkbox confirming settlement authority

Where to Send or File the Signed Consent Form

Route copies to the mediator, each party, and counsel. Some court programs require a filed copy or uploaded record before scheduling.

Mediator: Send a signed copy to the mediator for session records.
Each Party: Provide each party and counsel with a fully executed copy.
Court Program: If court-ordered, file or upload as required by local rules.
Provider Archive: Retain a copy with the mediation provider or ADR organization.

Delivery Options and Technical Requirements for eSigning

Choose a platform that supports the required fields, simple authentication, and secure storage for mediation documents.

File Types: PDF and DOCX supported
Integrations: Works with Google Workspace and Microsoft 365
Authentication: Email link or SMS code options

Typical Timing and Scheduling Expectations

Expect scheduling and document exchange timelines to vary; set clear deadlines for disclosures and pre-mediation statements to keep the process on track.

Exchange of Statements:

Often 7–14 days before the scheduled session to allow review.

Scheduling Window:

Sessions commonly scheduled within 30–60 days of consent.

Rescheduling Notice:

Provide at least 72 hours’ notice for cancellations or changes.

Payment Terms:

Mediator fees typically due prior to or on the session date.

Record Retention:

Signed consent forms should be stored per retention policy.

Common Mistakes When Preparing a Mediation Consent Form

Using informal or abbreviated names that do not match legal documents and create enforceability issues.
Failing to state whether the mediation is binding or non-binding, causing post-mediation disputes.
Omitting who has authority to settle, which can delay or void settlement approvals.
Neglecting confidentiality exceptions, which may lead to unexpected disclosure obligations later.

Consequences of Errors or Omissions in the Consent Form

Enforceability Risk: Incomplete forms can complicate enforcement of agreements

Delay: Missing signatures delay scheduling and resolution

Confidentiality Gaps: Vague terms may permit disclosure in later proceedings

Authority Disputes: Lack of settlement authority can void agreements

Cost Overruns: Unclear fee allocation may trigger disputes

Court Challenges: Improper execution may raise admissibility issues

eSignature Pricing and Capability Comparison for Mediation Consent Forms

Common vendor choices and feature considerations for eSigning mediation consent forms are shown below; signNow is listed first as a comparative reference.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Real-World Examples of Mediation Consent Use

The following scenarios illustrate common ways parties use a Mediation Consent Form to document expectations and authority.

Family Law Mediation

A divorcing couple signed a consent form to confirm confidentiality and parenting-time topics.

The mediator required authority confirmation.
The recorded consent prevented later claims the mediation was involuntary and allowed the court to accept the mediated agreement without additional testimony.

Commercial Contract Dispute

Two businesses agreed to mediation and used a consent form to document insurer approval requirements.

Signatures from authorized officers were included.
The clear authority language prevented a post-settlement rescission argument and expedited settlement implementation.

Key Milestones in the Mediation Process

Track these sequential milestones to keep the mediation organized from initial consent to final settlement or closure.

01

Consent Execution

Parties sign the consent form to confirm participation and consent to terms.

02

Pre-Mediation Exchange

Parties exchange statements, documents, and settlement positions in advance.

03

Mediation Session

The scheduled session occurs, in-person or remotely, per the consent form.

04

Settlement Documentation

Any agreement is drafted, signed, and archived per the consent terms.

Notarization and Witness Steps for Authentication

When notarization or witness attestation is required, follow these authentication steps to validate signatures.

01

Prepare Document

Present the unsigned original for witness and notary review.

02

Confirm Identity

Signers provide government-issued ID for verification.

03

Select Notary Type

Choose in-person or RON where permitted by state law.

04

Witness Attestation

Witnesses observe signature and sign as required.

05

Notary Acknowledgement

Notary completes the certificate and affixes seal.

06

Record Video (RON)

If RON used, retain audio-video recording per state rules.

07

Retain Journal

Notary records session details in the notary journal.

08

Distribute Copies

Provide notarized copies to parties and the mediator.

Frequently Asked Questions About Mediation Consent Forms

Answers to common questions about validity, eSigning, revocation, witness requirements, confidentiality, and record retention for mediation consent.

Need help? Contact support

Is an electronic signature valid?
Yes. Under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA (adopted in most states), electronic signatures are legally effective if they demonstrate intent and the record is retained.
Can a signer revoke consent after signing?
A party may withdraw consent subject to any terms in the agreement; however, withdrawal may not undo conduct already undertaken and could affect scheduling or enforceability of subsequent settlement documents.
Are mediations confidential?
Confidentiality depends on the consent form and state law. Many states protect mediation communications from admissibility; include explicit confidentiality language and any statutory exceptions.
When is notarization required?
Notarization is not typically required for mediation consent forms, but specific jurisdictions or related settlement documents may require notarization or witness attestation.
What if a signer lacks authority?
If an authorized representative signs without authority, the resulting settlement may be voidable; confirm and document settlement authority in the consent form to reduce risk.
How long should the form be retained?
Retention depends on applicable rules: follow IRS (IRC §6501(a)), HIPAA (45 CFR §164.530(j)), and any state-specific requirements; consult counsel for your situation.

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