Online Intake Form

To submit your Intake Form electronically please complete the fields below and click submit. If you prefer to submit manually, please fax or mail to:

Conflict Solutions of Texas, 6223 IH 10 West, San Antonio, TX 78201
Fax 210-247-9426

Intake Registration Form – PDF

  1. Parties

    Please identify the party for whom this Form is submitted.
    (e.g. Plaintiff, Defendant, Third Party Defendant, Intervenor, etc.).

    Name of Party (required):

     Plaintiff Defendant Third-Party Defendant Intervenor Other

    If Other, Please describe:

  2. Contact Information

    1. Please provide the name, mailing address, email address, telephone and fax number of the initiating or responding party’s designated representative or lead attorney, and all other attorneys who will appear on your behalf.

      Lead Attorney for Service (required):

      Other Counsel:

    2. Please provide the name, mailing address, email address, telephone and fax number of the opposing party’s designated representative or lead attorney, and all other attorneys who will appear on their behalf.

      Lead Attorney for Service (required):

      Other Counsel:

  3. Pleadings

    If this is matter is currently in litigation, please attach your most current pleading.

    Describe facts and circumstances pertaining to your dispute and any law or equitable doctrine supporting your claims or defenses:

  4. Insurance

    Please identify any liability insurance for parties against whom claims are asserted
    and provide the name, address, phone number, email address and fax number of the insurance carrier's claims representative.

  5. Description of Damages or Requested Relief

    Please describe, in summary form, the nature of the dispute and amount in controversy. (Note – If you have provided pleadings from pending litigation that you feel adequately identify the controversy, those pleadings will suffice.)

    Affirmative relief; requested remedies (required):

    Amount in Controversy (required):

  6. Witnesses

    Please provide the names and addresses of each fact witness and each expert witness who has knowledge of relevant facts in this matter. You may not have made final decisions in this regard; however, the most complete information you can furnish will facilitate an accurate conflict of interest check that will be conducted by CST arbitrator(s) and mediator(s).

  7. Pre-dispute Arbitration Contract

    If arbitration is requested pursuant to an arbitration provision within a contract, or a separate agreement to arbitrate, please attach complete copies of all written arbitration agreements.

  8. Court Orders

    Please attach a copy of any Court Order directing the parties to arbitration in this matter.

  9. Agreed Arbitrator

    If the parties have agreed on an arbitrator, arbitrators and/or mediator from the Conflict Solutions of Texas Panel, please indicate the agreed upon individuals:

    Arbitrator(s) (required):

  10. Arbitrator Appointment (AR-5)

    If the parties have not agreed on an arbitrator or, where applicable, a panel of arbitrators, CST will implement selection procedures, consistent with the parties' arbitration agreement and/or AR-5 of CST Rules of Arbitration. You may review the CST list of panelist on the website at www.csoftx.com.

  11. How did you hear about Conflict Solutions of Texas? (required)

CONFLICT SOLUTIONS OF TEXAS RULES OF ARBITRATION.

Subject to relevant and controlling provisions in the parties’ written arbitration agreement, the undersigned party and its representative(s) agrees to comply with Conflict Solutions of Texas Rules of Arbitration and consents to implementation of those Rules by the appointed arbitrator.

Your Email Address

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