Request an On-Site Interpreter – Online Tool


Request an On-Site Interpreter Online

Date the request is submitted to AVAZA

Name of your Agency or Department

ID number that identifies your agency and grants access to our services

Location name (e.g. XYZ Medical Center)

Physical Street Address

Suite, office or unit number

City where service is to be rendered

State where service is to be rendered

Zip Code where service is to be rendered

First and Last name of a contact person at your agency regarding this request

Phone number for Contact Person at your agency regarding this request

Date the Interpreter is needed at your location

Time Interpreter is needed at your location

Approximate time the Interpreter may be at the site

Must provide either patient's first or last name, or an ID number to identify the patient

Place of birth

Secure Transmission

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