Request an Interpreter...

Please note that all fields below are required and must be filled in...

Requester's name
(First and last name required)

Requester's e-mail address

Requester's phone number

Requester's company

Date of service requested
(format: xx-xx-xxxx)

Start time

End time (note: there is a 2-hour
minimum for all assignments)

Assignment location

Building

Street address

Room or
Suite number

City

State

Zip

Main telephone at location

Special instructions
(parking, name on
building cross streets,
plaza name, etc.)

On-site contact person

Contact telephone number

Name(s) of deaf/hard-of-hearing individual

Purpose of assignment
(choose one)

Medical/Hospital	Educational	Legal	Business Meeting
Mental Health	Training	Workshop	Conference/Convention
Social Services	Employment	Recreational	Religious Event/Ceremony

Additional information about
request (special needs,
type of meeting, number of
people, type of conference)

Billing information
(company name, address,
phone, billing contact name)

Case Number/Cost Center/
Purchase Order number

Have you used CODA Link's services before?

Yes

Have you reviewed our
Policy and Procedures?

Yes	No — Download a copy of our Policies and Procedures

Thank you for your request.
We will respond within 24 business hours upon receipt of this request.

*Please be advised all requests require at least a 48-hour notice. If you are requesting an interpreter within the next two business days (48 hours), please complete this request form and call our office to confirm receipt of this request. If you have an urgent or immediate request during business hours, please call our office at 954-423-6893 for assistance.