Interpreting Services Interest Form

Interpreting services can be arranged by calling the 24/7 Helpline at 419-522-4357 or filling out the form below.

Your Name (First and Last)

Your Phone Number

Your Email

Provider Name such as business, company, hospital, organization ect.

Date of Service (If your request is within 24 hours of service date, please call helpline at 419-522-HELP)

Start Time of the Assignment (AM or PM)

Estimated Length of Assignment in hours

Name of Deaf/DeafBlind/Hard of Hearing Individual

Street Address Line 1 (Location of Assignment)

Street Address Line 2 (Room Number, Apt Number)

City, State, Zip (Location of Assignment)

Appointment Type
CommunityDeafBlindDrug/AlcoholEducationLegalMedicalMental HealthVictim ServicesVocationalOther

Onsite Contact Person

Onsite Contact Phone

Onsite Contact Email

Additional Details

After hitting 'submit', you will be contacted within 1 Business Day. If your request is within 24 hours of date of service, please call helpline at 419-522-4357 (HELP). We are here to help!

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