Interpreter Cancellation Form

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Requestor

Requestor's First Name *

Requestor's Last Name *

Requestor's Email Address *

Requestor's Phone Number *

Deaf Consumer

Deaf Consumer's First Name *

Deaf Consumer's Last Name *

Consumer's Date of Birth *

Date To Be Cancelled

Date *

Start Time *

End Time *

Location

Name of Location *

Onsite Contact's First Name *

Onsite Contact's Last Name *

Onsite Contact's Phone Number *

Reason for cancellation

Terms and Conditions

IMPORTANT

By submitting this request, you agree to the terms below. Once the request is received in writing an email will be sent to your office to confirm your request. If your organization needs to cancel this request, AI Deaf 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 and must have an explanation as to why the auxiliary aid is being canceled. If cancellation notification is not made, AI Deaf Inc will invoice for the total amount of your request. In the event that the AI Deaf 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.

I agree to these terms and conditions *