services-form

Are you an existing Customer?

Yes No

Customer Name or Number

Interpreting or Real-Time Captioning:

Onsite or Virtual:

Date Services are needed:

Arrival / Check in time:

Start time of appointment:

End time of appointment:

Type of appointment

If Virtual: will this event be recorded and/or livestreamed:

yes no

If Medical appt, please list client DOB and MRN:

Deaf Client's Name:

Name of requested interpreter (if applicable):

Location Name:

Address for Appointment:

Building, Floor, or Station/Suite Number:

Contact Person

Phone

Email

Special Parking information:

Any additional specific information related to your request:

For meetings / trainings / conferences: Please attach a link to agenda/PowerPoint slides/preparation materials.

For theatrical productions / performances / graduations / ceremonies: Please attach program/script.

*NOTE about Virtual jobs: We must have the name and number of a contact person who can be reached in case of technical issues. Additionally, it is the responsibility of the customer to provide the link to the VRI meeting ahead of time. Please note that in some instances (such as a webinar), the interpreter may need to be sent an invitation to join as a 'panelist' so that the interpreting services are accessible at all times. For captioning requests the meeting host will need to "assign" captioning privileges to the Real-Time captioner.

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