Request for Sign Language Interpreter

2/1/2023 10:18:17 AM
Required Fields are in bold

Purchaser Information

Purchaser information refers to you, the individual making this request. It allows the Contractor to follow up with you as needed.

First Name		Last Name
Phone
Email
If you have not established an account with ODHH and/or contractor previously, or have not used the interpreting service in the past, please take the time to providing us information about your organization. Your entity is responsible for covering the interpreting cost of Sign Language Interpreters and Agency Booking Fees. Create an account Account Name (Agency/Unit/Organization)

Appointment Information

Appointment Date

Open the calendar popup.

Appointment Time

Start Time

End Time

Appointment Setting

Setting

Appointment Note

Please describe the appointment: For example: A Deaf child with hearing parents meeting for general checkup. A client is a DeafBlind adult coming in for a follow up appointment. More information is better.

Appointment Location

Provide a detailed description of the service location. This helps an interpreter to find the location successfully. Due to COVID, many appointments are now taking place through a Virtual Connection. Please add your physical location and the meeting’s Virtual information. If there is no virtual information, the Interpreter will show up at the physical location.

Location
Contact		Phone (If other than requestor)
Email (If other than requestor)		Text
Address
	Building	Floor	Room
City		State
Postal Code
Virtual Meeting
Virtual Meeting/Platform
Public
Mixed Group
Direction & Parking Note

Consumer Information

Provide information about the consumer who needs access. This includes preferred interpreters if any.

First Name:		Last Name:
Deaf Participant/Party (other than client/consumer name)
Gender

Date of Birth (mm/dd/yyyy)

Hearing Identity

Specific Interpreter Requested

You must select a contractor from the list below: Please note, not all contractors are statewide. If you need information about each Contractor, please go to ODHH's website.

Contractor

If you have any comments you want to relay to our contractors and/or interpreters, please enter them below.

Aging and Long-Term Support Administration