Mediation Support

Overview

Introduction

Wellbeing Solutions partners with carefully selected experienced mediators to deliver professional workplace mediation services across the UK. Our mediations are conducted virtually for accessibility and convenience.

Mediation is an effective way to resolve difficulties or potential disputes between employees. It provides a safe, private, and secure space for individuals to communicate openly, with the support of an independent and trained mediator. It can be particularly helpful in addressing interpersonal issues and complaints involving grievances, harassment, bullying, equal opportunities, dignity at work, and team conflicts.

How it works

Submit this form with all the relevant details.
Initial Review: Our team will review the referral and contact our mediation partners to check availability for initial one-to-one sessions with the individuals involved.
Coordination: A member of our Account Management team will liaise with the referrer to propose suitable dates and confirm the initial sessions.
Introduction & Setup: The mediator will contact the individuals to introduce themselves, send session invitations and arrange for any necessary mediation agreements to be signed.
Joint Session: Once one-to-one sessions are complete, we will coordinate a date for the joint mediation session.

Price: Standard 2 party mediation - £1,750.00

For urgent queries, contact Wellbeing Solutions at 020 7708 5000 or email customerservices@wsm-wellbeing.co.uk.

Your Organisation and Referrer Information

Please provide your organisation’s details and the contact information of the person submitting this referral. This ensures we can process the request efficiently and reach out if further clarification is needed.

Organisation name

HR referrer name

Job title

Telephone number

Mobile number (required if not office based)

Email address

Date of referral

Authorisation

Please provide the details of the manager authorising this referral. This ensures the request is formally approved within your organisation.

Authorisation same

The person making this referral is the authorisation manager

Authorising manager name

Job title

Telephone number (mobile is preferred)

Email address

Mediation Details

Please provide the following information about your mediation request. This will allow us to coordinate the response effectively. All details will be handled in strict confidence, in accordance with GDPR and Wellbeing Solutions' data protection policies.

What are the main objectives of this referral?

Describe the main presenting issues and key factors leading to this referral

Outline any specific questions/issues you would like covered

Are either of the employees absent at the time of this referral?

Yes No

Total number of absence days in current period

Employee 1 name

Employee 1 job title

Employee 1 contact number

Employee 1 email address

Employee 1 date of birth

Any language requirements

Summary of job role

How does this role interact with employee 2?

Does the employee know about this referral?

Yes No

Has the employee provided consent to participate in this process?

Yes No

Additional relevant information

Employee 2 name

Employee 2 job title

Employee 2 contact number

Employee 2 email address

Employee 2 date of birth

Any language requirements

Summary of job role

How does this role interact with employee 1?

Does the employee know about this referral?

Yes No

Has the employee provided consent to participate in this process?

Yes No

Additional relevant information

Med Support

Confirm Mediation Support

Please confirm the Mediation Support by selecting the option below:

Please confirm the Mediation Support by selecting the option below

Standard 2 party mediation - £1,750.00
Delivered virtually. One-to-one sessions conducted with each party, then a joint session.

Invoice recipient name

Job title

Telephone number (mobile preferred)

Email address

Postal address (including postcode)

Does your organisation require a purchase order number or finance reference?

Yes No

Please provide details of the purchase order number or finance reference

Terms and Conditions for Mediation Support Services

Commitment upon submission:
By submitting this referral form, the authorising manager confirms approval for Wellbeing Solutions to arrange additional counselling sessions as specified. This referral constitutes a binding contractual agreement.
Service confirmation and delivery:
Wellbeing Solutions will contact the employee directly to arrange counselling sessions based on the selections made in this form. Sessions will be delivered by qualified clinicians in line with Wellbeing Solutions’ clinical governance standards and the BACP Code of Ethics.
Confidentiality:
The employee’s identity, previously confidential under the EAP self-referral process, has been voluntarily disclosed for the purposes of this referral. All personal and session details will remain confidential and managed in line with GDPR and the Data Protection Act 2018.
Cancellation policy:
- Three or more working days’ notice: 50% of the agreed fee will be charged.
- Anything less than three working days: 100% of the agreed fee will be charged.
- Rescheduling requests made with less than three working days’ notice will incur a £50 administrative fee in addition to the standard cancellation fees.
Payment terms:
- You will be invoiced for all billable sessions outlined above upon receipt of this order.
- Invoices are due within 30 days of issuance.
- Late payments may incur interest at 4% above the Bank of England base rate, calculated daily from the due date.
Safeguarding:
Any risk or safeguarding concerns disclosed within this form will be managed in line with Wellbeing Solutions’ safeguarding policy. For immediate concerns, please contact emergency services by dialling 999.
Liability:
Wellbeing Solutions shall not be liable for indirect or consequential loss arising from the delivery of services, including delays caused by circumstances beyond reasonable control.
Clinical governance:
Counselling sessions will be provided by clinicians adhering to Wellbeing Solutions' clinical governance standards and the BACP Code of Ethics.
Amendments to This Agreement:
Any changes to this referral must be requested in writing and confirmed by Wellbeing Solutions prior to implementation.

Acknowledgment and agreement:
By checking the box below, I confirm that I have read, understood, and agree to the terms and conditions outlined above.

Terms

I agree to the terms and conditions.

Authorisation and Submission

By completing the fields below and clicking "Submit," you confirm your request for additional counselling sessions as outlined in this referral form. Upon submission:

An Adobe-signed PDF will be generated and emailed to the contact email address provided.
A copy will also be sent to Wellbeing Solutions to initiate the order process.
A member of our team will contact you shortly to finalise details and confirm the booking.

Full name

Job title

Date

Signature

Progress bar

Introduction

How it works

Your Organisation and Referrer Information

Authorisation

Mediation Details

Confirm Mediation Support

Terms and Conditions for Mediation Support Services

Authorisation and Submission