Cancel or Reschedule Existing Appointment – Pure Language Services, Inc.

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859-312-8559

apply@purelang.com

859-312-8559

apply@purelang.com

Cancel or Reschedule Existing Interpreter Request

If you are human, leave this field blank.

Do you need to cancel or reschedule an interpreter for an appointment taking place WITHIN THE NEXT 3 BUSINESS DAYS? *

YES

To cancel or reschedule a request for an interpreter that will occur within the next 3 business days:

Please call our direct line at 859.312.8559 and speak directly to our dispatcher on-call who will assist you. Thank you!

Would you like to cancel or reschedule an interpreter request? *

CANCEL

RESCHEDULE

Name of Clinic *

Clinic Contact Name

Clinic Phone Number

Language *

Arabic

Chinese (Mandarin)

French

Kinyarwanda

Nepali

Russian

Spanish

Swahili

Ukrainian

Original Appointment Date *

Please use the calendar pop-up for date entry. If typing the date directly, format as DD/MM/YY; other formats will cause errors.

Original Appointment Time *

Patient Name *

Medical Record Number *

New Appointment Date

Please use the calendar pop-up for date entry. If typing the date directly, format as DD/MM/YY; other formats will cause errors.
LEAVE BLANK IF APPOINTMENT IS CANCELLED

New Appointment Time

Please do NOT list the patient’s arrival time. The interpreter will arrive 15 minutes before the appointment time.
LEAVE BLANK IF APPOINTMENT IS CANCELLED

Changes to the appointment type or provider/additional notes *

Your Name *

Your Direct Phone Number *

Your Email Address *

Please click the submit button only once, and then wait for the confirmation screen.

CONFIDENTIALITY STATEMENT

THIS IS A SECURE MESSAGE WHICH WILL BE DELIVERED SOLELY TO PURE LANGUAGE SERVICES, INC. ANY DISCLOSURE, COPYING, DISTRIBUTION, OR TAKING OF ANY ACTION IN RELIANCE ON THE CONTENT OF THIS INFORMATION OUTSIDE OF THE TREATING TEAM FOR THIS PATIENT IS STRICTLY PROHIBITED.

Pure Language Services, Inc.

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