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Request an Interpreter

Appointment Details

Deaf Consumer's First Name

Deaf Consumer's Last Name

Consumer's Date of Birth

Name of Location

Appointment Type

Interpreting Location

Street Address

Street Address Line 2

City

State

Zip Code

Specific instructions for Interpreter upon arrival:

Date and Time

Date

Start Time

End Time

Requestor Information

Requestor's First Name

Requestor's Last Name

Requestor's Email Address

Requestor's Phone Number

Billing Department's Email Address

This is where the invoice for services will be sent

Onsite Information

Onsite Contact's First Name

Onsite Contact's Last Name

Onsite Contact's Phone Number

Director's First Name

Director's Last Name

Cost Center

Additional Information

Terms and Conditions

IMPORTANT

Once this request is received, AIDeaf will proceed with scheduling and confirming services. An email will be sent to your office to confirm your request has been assigned an interpreter. If your organization needs to cancel this request, AIDeaf Inc must be notified in writing no less than 2 business days before the scheduled appointment. The cancellation form must be filled out online at www.aideaf.com. All cancellations must be in writing. If cancellation notification is not made OR it is made within 48 hours of the scheduled request, AIDeaf Inc will invoice for the total amount of the request. By submitting this request, I agree payment of services will be due UNLESS canceled more than 48 hours. In the event that AIDeaf Inc is unable to provide an interpreter, your office will be notified as soon as possible, no later than 1 business day before the scheduled assignment.

Do you agree?