Document Translation Request Form

Completed forms to request Document Translations from English to Spanish or Spanish to English, will be routed to our Interpreter Services team for assignment. Any other languages will be sent to Language Line to request a quote, your department will not charged until you approve the amount.

Requestor Information Requestor Information * First Last
*

VP Director Manager Supervisor Lead Partner Other Other
Email *
Phone Phone - ### - ### ####
Choose your facility according to location and specialty.
Skip Specialty, if a department is sending the form, i.e. Marketing or Revenue Cycle.

This will help us keep records of all services provided.
Facility
Specialty

Skip this if a department is sending the form, e.g. Marketing or Revenue Cycle.
Provider - Optional

Use if Marketing or a nurse is sending the form on behalf of a provider.
i.e. (nurse name) on behalf of John Mercy, MD or (marketing partner) on behalf of Jane Health MD
Department
Sub-Department

i.e. If you chose Revenue Cycle as your department, your Sub-Department could be: Commercial Follow-up or Customer Service.

Document Translation Request Form

Document Translation Request Form

Choose your facility according to location and specialty. Skip Specialty, if a department is sending the form, i.e. Marketing or Revenue Cycle.

Choose your facility according to location and specialty.
Skip Specialty, if a department is sending the form, i.e. Marketing or Revenue Cycle.