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Puzzle Etni — Conflict Resolution Request Form

For Workplace Dynamics, Mediation, and Organizational Health Support
Puzzle Etni supports organizations in preventing, addressing, and resolving conflicts through structured analysis, guided mediation, and proactive cultural practices.
This form helps us understand your situation at a high level before defining scope, confidentiality terms, and appropriate methods.

Contact Information

Name

Preferred Contact Method

Preferred Contact Method
A
B
C

Contact Details

Organization / Activity

Organizational Context

What type of environment does your request relate to?

What type of environment does your request relate to?
A
B
C
D
E
F
G
H

Geographic Context

Geographic Context
A
B
C
D
E
F
G

Nature of the Concern

Please select one or more general categories — no sensitive details required at this stage.
Nature of the Concern

Type of Support Requested

A. Analysis and Early Diagnosis

A. Analysis and Early Diagnosis

B. Mediation & Guided Dialogue

B. Mediation & Guided Dialogue

C. Organizational Development & Prevention

C. Organizational Development & Prevention

High-Level Description

(No sensitive names, details, or accusations are needed.)

Expected Outcomes

What would you like Puzzle Etni to help you achieve?
Expected Outcomes

Timeline & Priority

Timeline & Priority
A
B
C
D
E

Preferred Approach or Constraints

Preferred Approach or Constraints

Additional Information (Optional)

Acknowledgment & Disclaimer

By submitting this form, you acknowledge that:

Does not create obligations for either party,

Serves only to allow Puzzle Etni to make an initial assessment,

Does not constitute a mediation, advisory, or legal service until an agreement is made,

And further details may require a confidentiality arrangement before proceeding.
Acknowledgment & Disclaimer