Request for Sign Language Interpreter

5/6/2021 8:35:35 AM
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

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

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.

Interpreting Provider:

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