Mediation Engagement Forms (MWI)


We are requesting mediation services from Ben Stich of Mediation and Family Services, and understand and agree to the following terms:

  1. We are the decision makers in this process and the mediator cannot impose any decisions regarding the disputed issues.
  2. Mediator services shall not be construed as legal advice, financial advice, therapy or any professional service other than mediation. Either of us may seek expert advice at any time during the mediation. The mediator has advised each of us to have separate, independent counsel review any agreement before we sign it.
  3. Mediation is a voluntary process. The mediator or we may choose to end the process at any time.
  4. If we discuss finances, we will disclose all of our financial worth, assets and liabilities during the mediation process. We each accept full responsibility for the reasonable accuracy of the figures disclosed and understand that agreements reached will be based in part on these figures.
  5. We understand that mediation is a confidential process under Massachusetts General Law Chapter 233, Section 23C and that Mediation and Family Services will keep the details of our case and all related documents confidential.The mediator reserves the right to disclose suspected abuse and plan to commit a crime to the proper authorities. We agree that neither of us will seek to obtain the testimony of the mediator or the disclosure of the mediator’s file in conjunction with any court proceeding, and we further agree that if one of us seeks such testimony or disclosure in contravention of this provision, that person will indemnify the mediator as to all costs in connection therewith, including attorney’s fees, preparation, and travel time, and will compensate the mediator for time spent such compensation to be at the mediator’s then current hourly rate.
  6. We understand that Ben Stich is a licensed social worker which means under Massachusetts General Law Chapter 119, Section 51A, he is a mandated reporter and must report to the Department of Children and Families when he has reasonable cause to believe that a child under the age of eighteen years is suffering physical or emotional injury resulting from abuse or neglect.
  7. The mediator’s notes are his private memory aids that will not be shared. The mediator can set forth any agreement reached in mediation in a Memorandum of Understanding, or other written document upon our request.



We, the below signed parties, understand and agree to the following:

  1. We will pay a total of $400 per hour for mediation services to Ben Stich.
  2. Should we choose to split the cost of mediation each of us will pay $200 per hour for joint mediation sessions.
  3. Should we choose to split the cost of joint mediation sessions, we understand that we will pay $400 per hour for individual sessions.
  4. Payment for services is due at the end of each mediation session by cash, check or credit card.
  5. Sessions are scheduled at a two-hour minimum. If the full time is not used we understand that Ben Stich reserves the right to a minimum fee of one hour per session.
  6. If we cancel a mediation session or similar appointment with less than at least 24 hours’ notice, we will pay the amount equal to the fee for half of the scheduled time.
  7. We agree to prepay a deposit of $800 ($400 if splitting the cost) prior to the commencement of the mediation process, which will be applied toward mediation services rendered, including preparation for mediation sessions and document drafting. If at any time the two-hours of pre-paid time is depleted, we agree to be charged one hour of additional time. Any unused funds will be refunded to you upon written notification of termination of mediation services.
  8. The same hourly rate listed above applies to additional services that might be provided outside of mediation sessions, including:
    • Preparation of written materials such as progress summaries and draft agreements;
    • The drafting of the Memorandum of Understanding and Separation Agreement;
    • Email and phone communication;
    • Preparation for mediation sessions;
    • Any other written document that is requested
  9. There is never a fee for contacting Ben Stich for scheduling or other administrative purposes.
  10. We will pay for documents in full before they are released to us.
  11. We give permission to Ben Stich to charge our credit card for mediation services as described above, unless we have paid by cash, check or debit card via Quickbook invoice.
  12. Ben Stich will not provide additional mediation services until all late fees and associated balances are paid in full.
  13. A late fee of 20% of the outstanding balance will be added to the total amount due if payment is not received within 30 days after services are rendered or documents are drafted.


Technology: If online sessions occur we will use Zoom. Before your first scheduled session, you agree to download and install the software and/or apps from Zoom necessary for your participation at: To familiarize yourself with how to operate Zoom tutorials are available at I recommend using a computer if you have one available to you. You will need a secure WiFi or Ethernet connection for your computer. Despite best efforts there are times technology may fail to operate properly. If that happens, please take the following steps:

  1. Log out of Zoom and log back in
  2. Call Ben at 617-872-7721 for troubleshooting help

Privacy: Only the people engaged in the mediation process may join an online session. You agree to disclose immediately when someone else is in the room off-camera and take measures to ensure no one else can overhear the session. You will not allow your children to hear any portion of the session. If a child walks in the room you will immediately inform the group and turn your volume off until the child is out of earshot.

Prohibition on Recording: You, or anyone on your behalf, may not audio or video record any mediation session or portion thereof. In the event that you learn of an audio or video recording of any session, you will take immediate action to destroy the recording and inform all parties to the mediation. You will not disseminate the recording to third parties. You further agree that you will not transmit a live or deferred video or audio relay of the online mediation sessions to third parties.

Respectful Online Communication: Due to the nature of the online forum, it is especially important to allow each participant to finish their comments or statements before responding. The audio portion of the technology will only allow one person to talk at a time. In addition, the online format can amplify and exaggerate sound so maintaining a regular speaking voice is important. If I request use of the “mute” feature while someone else is speaking you agree to do so.

You agree to present yourself in the same business-like manner you would if you were in an office conference room. To that end, you will not participate in a session while driving, under the influence of alcohol or other substances, and ensure your background is neutral (ex. free from things that could upset the other party, such as a photo of a significant other).

Mediation Engagement Forms

I read, I understand, and I agree to the terms of Mediation and Family Service's Agreement to Participate in Mediation, Fee Agreement, and Online Protocol for mediation services(Required)
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