Correction to a Previous Interpreter Request

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859-312-8559

apply@purelang.com

859-312-8559

apply@purelang.com

If you are human, leave this field blank.

Do you need to correct an appointment taking place WITHIN THE NEXT 3 BUSINESS DAYS? *

YES

To correct an existing appointment 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!

Name of Clinic *

Clinic Contact Name

Clinic Phone Number

Language *

Arabic

Chinese (Mandarin)

French

Kinyarwanda

Nepali

Russian

Spanish

Swahili

Ukrainian

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.

Appointment Time *

Patient Name *

Medical Record Number *

Please specify which field contained incorrect information. *

(e.g., Patient Name, Medical Record Number, etc.)

Please specify the correct information below. *

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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