Service Request Form | Arizona Freelance Interpreting Services

If you need Video Remote Interpreting services please make sure you choose that option at the very end of this form!

Requester's Name *

Requester's Email Address *

Requester's Phone Number *

Billing Information

Company/Organization Name *Name Of Company or Organization Paying For Services0 / 180

My Organization Already Has An Account With AZFLIS

New Customer Account Setup Info

We look forward to providing a remarkable interpreting experience for your organization.

We do need to get a rate sheet on file to get your account setup in our scheduling software first.

Please download the AZFLIS Rate & Policy Sheet and email the completed form to scheduling@azflis.com

Feel free to contact our office for more information at 480-595-9515

Appointment Scheduling Information

Please Provide As Much Information As You Can

Date Of Service *

Start Time

Hours

Minutes

End Time

Hours

Minutes

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Crossroads *

Select Location Building Type *

Is Your Company/Business Name On The Building At The Address Listed Above? *NoYes

Name on building or other identifiable information. *

Appointment Details

Deaf Consumers Name *

Interpreting Service Needed *

To Assure Interpreters Are On Site, On Time.

Please be aware, the interpreter will be scheduled 15 minutes prior to the scheduled start time to assure that they have time to park, gain entrance and find their designated area to perform on time.

Appointment Type *

Mode Of Interpreting *

Is VRI an option if no "in person" interpreter is available? *If we cannot secure an in person interpreter for your needs, may we consider a qualified interpreter via video connection at your location?

Who Will Provide The VRI Link? *

Legal Assignment Type *

Travel Time Notification

Please be aware, portal to portal travel time will be billed for any medical emergency including hospital emergency room visits.

Will the interpreter be required to travel to a second location for burial? *

Please explain the travel requirements.

Where does the interpreter need to check in? *

This type of job must be scheduled 15 minutes prior to the event. *I acknowledge that the start time I have entered is at least 15 prior to the start of the live event.Check above to acknowledge.

Will the interpreter be recorded? *

Will the interpreter be on stage? *

Where does the interpreter park, is it free, can it be validated? *

Special instructions to gain entrance if there is a gated entrance or entry fee? *

Special instructions to gain entrance or entry fee?

Is this for a specific deaf individual or just in case deaf attend? *

Can we get copies of sermon or any other speaking points, songs, etc. *

What religion will be observed by the attending? *This helps us assure we find an interpreter that is a good fit for the event.

What is the name of the conference and what is the nature of the content being presented? *

Is there a script or other materials available before hand? *

What type of setting; funeral, church services, religious counseling...etc. *

Will the interpreter need to interpret each individual name or will the names be displayed on a screen? *

Will the interpreter be required to wear a cap and gown? *

Where will the interpreter be seated/positioned? *

Are any deaf individuals presenting/will interpreters be voicing for anybody? *

Is this for an indoor or outdoor event? *

Can the interpreter dress casually? *

How many people present, deaf and hearing? *

What type of review? 6 month, Annual, etc *

Is this a Lecture, Presentation, Q and A session or a 1 on 1 meeting? *

Class Type *

Students Grade Level *

Is there a sub folder? Where is it located? *

Which building does the interpreter need to enter? *

Is this a lecture style class or a lab? *

What is the class/course name? *

What is room number is the class? *

What is the nature of the training? *

Style Of Training *

Is there as different entrance/parking after hours? *

What is the medical issue Consumer is being seen for? *

Dr. Name *

What is the patient's ER bay or room number? *

What type of appointment? *

Is this request for a behavioral setting? *

Should the interpreter arrive prior to appointment time for patient check in? *

Is this in a medical complex? If so, where does the interpreter park and enter? *

Deaf Consumer's Age *0 / 180

Does the patient have a violent history? *

Is the patient currently in restraints or on suicide watch/observation? *

Will there be a video presentation? *

Is there a speaker/presenter or is this an open format meeting? *

Is deaf consumer Plaintiff, Defendant, Victim or Witness? *

What is the nature of the case? *

What are the charges? *

Docket, Case or Report # *

Will the opposing legal counsel have their own interpreters? *

How will the interpreter be utilized? *

What is the nature of the interview? *

Requesting officer or detective's badge # *

What type of trial is this for? *

What type of hearing is this for? *

Extra Information *0 / 180

On Site Contact Information

Please Make Sure We Have A Valid Contact For Our Interpreters On Site.I Am The Onsite Contact And Have Listed My Mobile Number PreviouslyThere Will Be Somebody Else On Site, Let Me Add Their Contact Info

Name Of On Site Contact *

Phone # Of On Site ContactPlease Provide Mobile Number If Possible

eMail Address For On Site Contact0 / 180

Finalize & Submit

Upload file

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Please upload any scripts, site maps or other useful documents here.

Please provide any information about the working environment that will be helpful to the agency or interpreter(s) provided.

Do you have a PO for services?