Schedule an Interpreter - Deaf Services Unlimited

Requester Information

Name of Company or Organization*

Requester Name*

First

Last

Requester Phone*

Extension

Requester Email*

Enter Email

Confirm Email

Have you used our services before?*

Billing Address

If no, please provide us with your billing address and billing contact person.

Billing Contact*

First

Last

Billing Address*

Street Address

Address Line 2

City

State

ZIP Code

PO or Routing Code Number

Can the invoice be emailed?*

Billing Email*

Enter Email

Confirm Email

Appointment Details

Type of Services Requested*

There is currently an industry-wide increased demand for remote captioning services and as a result, provider schedules are booking earlier than usual. At this time, we are most successful in filling assignments with a minimum of two weeks’ notice. We understand that your needs cannot always be planned two weeks in advance, so our team will always do our best to fill each request. We appreciate your understanding. We will get to work on this right away and will do our best to secure a captioner for this request. If you have the opportunity, please encourage your teams to provide advance notice and let us know right away of any updates or changes.

Name of Deaf Client*

Date of Appointment*

Start Time Interpreter Needed*

:
HH

MM

Start Time CART Writer Needed*

:
HH

MM

End Time Interpreter Needed*

:
HH

MM

End Time CART Writer Needed*

:
HH

MM

Timezone*

Location Name*

Exact Address of Appointment*

Street Address

Address Line 2

City

State

ZIP Code

Department, Building, Suite or Floor Number

Additional Details

Reason/Type of Appointment/Meeting*

Additional Location Information (security, parking, etc.)

Other Attendees and Their Role(s)

PO or Routing Code Number

If Requested, Name of Preferred Interpreter

Additional Information

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