INTERPRETING REQUEST FORM - Valley Center of the Deaf

Do you have already have a account or agreement with us? *

Organization Name: *

Requester's (YOUR) Name: *

First

Last

Requester's Email: *

Confirm Email

Deaf Consumer's (OR Patient's) Name: *

First

Last

Deaf Consumer's Date of Birth (Medical appointments only)

Company Phone #: *

Company address: *

Phone # type:

Alternate Phone #:

Alternate Phone # type:

Language(s) Needed: *

Type of Interpreting Needed: *

On-site (address where you need the interpreter): *

Virtual - provide your own link OR we can provide a HIPAA compliant Zoom link.

Nature of appointment (Please be detailed - ex: doctor appointment for high blood pressure, follow up for bloodwork results, conference on retirement planning, job interview for computer networking, etc) *

Date(s): *

Check in time: *

Start (or appointment) time: *

End time: *

Additional information and/or instructions

Graphic image with blue letters spelling out V-C-D on a white background. Hands signing each of the letters V-C-D are on the front of the letters

VALLEY CENTER OF THE DEAF

Graphic of a church with a cross on top. The words beneath the church read Catholic Community Services of Southern Arizona, Inc in white letters.

WORKING HOURS

Monday-Friday: 8a - 5p

Saturday - Sunday: Closed

VALLEY CENTER OF THE DEAF

WORKING HOURS

SOCIAL MEDIA