State statute
San Francisco — Mediation Consent and Confidentiality Form
California foreclosure, tax-defaulted, court-ordered and probate-sale law and official procedures — verbatim and citable.
- Edition
- 2026-09-26
- Last updated
- 2026-09-27
- Jurisdiction
- San Francisco
San Francisco — Mediation Consent and Confidentiality Form¶
Page 1¶
Attorney Name(s) or Party without Attorney 1 Firm Name 2 Mailing Address City, State, Zip Code 3 Phone Number(s) Fax Number 4 Email Address
5 Attorney for (Name) or Self-Represented 6 SUPERIOR COURT OF THE STATE OF CALIFORNIA 7 COUNTY OF SAN FRANCISCO 8
9 Conservatorship/Guardianship of: Case Number:
10 MEDIATION CONSENT AND 11 ☐ Person: (Name) CONFIDENTIALITY FORM ☐ Estate: (Name) 12
13
14 We have agreed to try to resolve our problem through mediation.
15
16 The mediation will be conducted by a mediator from the San Francisco Superior Court
17 Probate Mediation Panel.
18 I understand that:19
20 1. The Mediator is serving only as a neutral person and does not represent either 21 party in an attorney/client relationship, nor can he or she give legal advice to any 22 party. 23 2. Each Participant has the right to be assisted by his or her legal counsel if 24 desired. The attorney for the (proposed) conservatee or (proposed) ward will be 25 present at the mediation and can participate.
26 3. Participation is completely voluntary. No party gives up any rights to due process
27 under the law if we do not agree to a settlement. The decision to settle a case
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 1
PRB-PCN-003 Rev. Sep-03-2018
Page 2¶
can only be made by a mutual agreement between the parties. Either party is 1 free to leave the mediation at any time and proceed to trial. 2 4. Communications between Participants and the Mediator are confidential 3 pursuant to California Evidence Code 1115-1128, except that Mediators shall 4 report to the Probate Court any information concerning child abuse or elder 5 abuse, as well as information concerning the commission of a crime of violence.
6 5. Any mediation agreement resulting from the mediation will be presented to the
7 Probate Court for approval.
8 6. Participants agree that the Mediator will not be called as a witness by any of 9 them to testify in Court (pretrial, trial or post-trial) or any other proceeding whether or not the mediation results in an agreement.10
11 Date: 12 Signature Printed Name: 13 Date: 14 Signature 15 Printed Name:
16 Date: Signature17 Printed Name: 18 Date: 19 Signature Printed Name:20
21 Date: Signature 22 Printed Name:
23 Date: 24 Signature Printed Name: 25 26 Date: Signature 27 Printed Name:
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 2
PRB-PCN-003 Rev. Sep-03-2018
Page 3¶
CONFIDENTIAL
1 Attorney Name(s) or Party without Attorney 2 Firm Name Mailing Address 3 City, State, Zip Code Phone Number(s) 4 Fax Number 5 Email Address
6 Attorney for (Name) or Self-Represented
7
8 SUPERIOR COURT OF THE STATE OF CALIFORNIA
9 COUNTY OF SAN FRANCISCO
10 Conservatorship/Guardianship of: Case Number: 11
12 MEDIATION AGREEMENT ☐ Person: (Name) 13 ☐ Estate: (Name)
14
15 16 This Mediation Agreement is admissible pursuant to Evidence Code Section 1123 and subject to Probate Court approval.17
18 We agree that: 19
20
21
22
23
24
25
26
27
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 3
PRB-PCN-003 Rev. Sep-03-2018
Page 4¶
CONFIDENTIAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 4
PRB-PCN-003 Rev. Sep-03-2018
Page 5¶
CONFIDENTIAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 5
PRB-PCN-003 Rev. Sep-03-2018
Page 6¶
CONFIDENTIAL
1 Date: 2 Signature Printed Name: 3
4 Date: Signature 5 Printed Name:
6 Date: 7 Signature Printed Name: 8 9 Date: Signature 10 Printed Name:
11 Date: 12 Signature Printed Name: 13 Date: 14 Signature 15 Printed Name:
16 Date: Signature17 Printed Name: 18 Date: 19 Signature Printed Name:20
21 Date: Signature 22 Printed Name:
23 Date: 24 MEDIATOR Signature Printed Name: 25
26
27
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 6
PRB-PCN-003 Rev. Sep-03-2018
Page 7¶
Attorney Name(s) or Party without Attorney 1 Firm Name 2 Mailing Address City, State, Zip Code 3 Phone Number(s) Fax Number 4 Email Address
5 Attorney for (Name) or Self-Represented 6
7 SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 COUNTY OF SAN FRANCISCO 9
10 Conservatorship/Guardianship of: Case Number:
11 ORDER APPROVING MEDIATION 12 ☐ Person: (Name) AGREEMENT ☐ Estate: (Name) 13
14
15
16 The Court hereby approves the Mediation Agreement of (date) . 17
18 Date: Judicial Officer19
20
21
22
23
24
25
26
27
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 7
PRB-PCN-003 Rev. Sep-03-2018
Page 8¶
Attorney Name(s) or Party without Attorney 1 Firm Name Mailing Address 2 City, State, Zip Code Phone Number(s) 3 Fax Number Email Address 4 Attorney for (Name) or Self-Represented 5
6 SUPERIOR COURT OF THE STATE OF CALIFORNIA 7 COUNTY OF SAN FRANCISCO 8
9 Conservatorship/Guardianship of: Case Number:
10 MINUTE ORDER REFERRING CASE TO 11 ☐ Person: (Name) PRO BONO MEDIATION ☐ Estate: (Name) 12
13
14
15 The parties and their attorneys are hereby ordered to Pro Bono Mediation. The
16 parties are directed to schedule a mediation session with a mediator agreeable to the
17 parties from the attached list.
18 19 Mediation must be completed no later than .
20 Status Conference is hereby set for in 21 Department 204 at . 22
23 Date: 24 Judicial Officer
25
26
27
28
MEDIATION CONSENT AND CONFIDENTIALITY FORM - 8
PRB-PCN-003 Rev. Sep-03-2018