Request an ASL Interpreter

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Appointment Details

Deaf Consumer's First Name *

Deaf Consumer's Last Name *

Consumer's Date of Birth *

Name of Location *

Appointment Type *

Other Appointment Type

Interpreting Location

Street Address *

Street Address Line 2

City *

State *

Zip Code *

Specific instructions for Interpreter upon arrival:

Date and Time

Date *

Start Time *

End Time *

Requestor Information

Requestor's First Name *

Requestor's Last Name *

Requestor's Email Address *

Requestor's Phone Number *

Billing Department's Email Address *

This is where the invoice for services will be sent.

Onsite Information

Onsite Contact's First Name *

Onsite Contact's Last Name *

Onsite Contact's Phone Number *

Director's First Name

Director's Last Name

Cost Center

Additional Information

Terms and Conditions

IMPORTANT

Once this request is received, AI Deaf will proceed with scheduling and confirming services. An email will be sent to your office to confirm your request has been assigned an interpreter. If your organization needs to cancel this request, AIDeaf 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. If cancellation notification is not made OR it is made within 48 hours of the scheduled request, AIDeaf Inc will invoice for the total amount of the request. By submitting this request, I agree payment of services will be due UNLESS canceled more than 48 hours. In the event that AIDeaf 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 *