Deaf Community Services of San Diego, Inc. | Interpreting and Communication Services

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Request an Interpreter Online Form

Service Date:	Start Time:	am pm
Day of the week:	Medical Check-In Start Time:	am pm
	Est. End Time:	am pm
Check if requesting service for a COUNTY funded program: NO YES
Name of Deaf Person(s): (if more than one person, use comma "," after the first name)	Nature of Appointment:
Agency:	Person requesting service:
Phone: Voice VP/TTY	Email:
Fax:	Appointment Location:
Site Contact Person:	Site Phone Number:
If Applicable: Medical Record #:	Case/code #:
Interpreter Preference: (Eg: Male, Female, preferred Interpreter's name, etc.)
Other:	Additional Information / Comments:
Mail your invoices to the address below (fill the blanks in the box): Company Name: Attention: Address: City: State: Zipcode: Phone: Fax: Email:	DCS Billing Department will contact you with the given information. Thank you for doing business with us!
For first time clients, please click here to view Rate and Service Agreement

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