Contact Us

Metamora Mediation LLC
Elkhart, IN 46516 USA
(574) 522-2222

Please provide your Contact Information on Form 1 below and enter any comments and questions in the space provided.

If you are engaged in a dispute and would like us to provide the other party with information introducing the process of Mediation and inquire regarding their willingness to consider this voluntary, non-adversarial approach to conflict resolution, please complete Forms 1 & 2 below.

If you are ready to schedule a Mediation session, please complete Form 3 below.

 Form 1:  Comments and Questions
Your First Name:
Your Last Name:
Your Address Street 1:
Your Address Street 2:
Your City:
Your Zip Code: (5 digits)
Your State:
Your Daytime Phone:
Your Evening Phone:
Your Email:


Form 2:                  Second Party's Contact Information

Please provide the Second Party's Contact Information in this form.

First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Evening Phone:


    I have read the Agreement to Mediate and request Metamora Mediation, LLC, provide Mediation services in accordance with these guidelines.
    I am sending a $450 certified check or money order for the Mediation services fee to:   Metamora, LLC
                                            1001 St. Clair Avenue
                                            Elkhart, IN  46516 USA

I understand a time and place for the Mediation will be established once both (all) the Parties have completed this Request for Mediation and provided payment.

My First Name:
My Last Name:
My Address Street 1:
My Address Street 2:
My City:
My Zip Code: (5 digits)
My State:
My Daytime Phone:
My Evening Phone:
My Email:
My Attorney (If any):  
 Attorney's Telephone:  
 Attorney's Address 1:  
 Attorney's Address 2:  
 Attorney's City:  
 Attorney's Zip Code:   (5 digits)
 Attorney's State:  
 1st Best Date:  
             Best Time: 8:00 am - 12:00 pm    
3:00 pm - 7:00 pm    
5:00 pm - 9:00 pm
2nd Best Date:  
             Best Time: 8:00 am - 12:00 pm    
3:00 pm - 7:00 pm    
5:00 pm - 9:00 pm
 3rd Best Date:  
             Best Time: 8:00 am - 12:00 pm   
3:00 pm - 7:00 pm    
5:00 pm - 9:00 pm
Request for Permission for named individual(s) to attend the Mediation Session:
 Individual's Relationship:  
 Attendance Restriction: Anyone not directly involved in the dispute, will not be allowed in the Mediation session!
Explain how this person (s)is directly involved in this dispute and absolutely necessary in the decision making process: