Aging and Long-Term Support Administration

Request for Sign Language Interpreter

2/24/2021 8:44:57 PM
Required Fields are in bold

Requestor Information

Requestor 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. 

Account Name (Agency/Unit/Organization)


If you didn't see your Agency/Unit/Organization in the list then please create your account.
Organization or Agency or Unit
Tip - The name of organization/agency/unit refers an organization who is making the request and will be responsible for payment. Once submitted, a system will set up an acccount in our system for your organization for future requests. 
Bill Contact
Bill Phone x
Bill Fax x
Bill Email  
Billing Address
Billing City
Billing State
Billing Postal Code

Appointment Information


Appointment Date
RadDatePicker
RadDatePicker
Open the calendar popup.
 
Appointment Time Start Time
End Time
Appointment Setting
Appointment Setting
Appointment Note Please describe the appointment: For example: A Deaf Child with Hearing parents meeting for general checkup Client is a DeafBlind Adult coming in for 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 (If other than requestor) Phone  (If other than requestor)
Email (If other than requestor)   Text
Address  
Building
Floor
Room
City State
Postal Code
Virtual Meeting
Virtual Meeting/Platform
Direction & Parking Note

Client/Employee Information

Provide information about the client/consumers being serviced. This includes special requirements and preferences.
Client/Employee Name Gender
Date of Birth (mm/dd/yyyy)
Hearing Identity
Specific Interpreter Requested

By default, this request will be submitted to all interpreting agencies that have a service coverage in the appointment city. If you prefer this request to send to a specific provider then please select the provider list below.

Interpreting Provider:

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


Submit Your Request