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:
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 #:
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
Please enter the characters you see in the image:
	Why?
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