Book An Alternative Communication Facilitator/Request An Alternative Communication Service
Contact Details
Booking Person Details
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company
Company Name
Street Address Line 2
City
State / Province
Postal / Zip Code
Service Recipient Contact Details
Same As Above
Name
First Name
Last Name
Gender
Male
Female
Non Binary
Age
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am
Deaf
deaf
Hard of Hearing
None of the above but require assisted communication
Alternative Communication Services
Tick Required Service(s)
Lip Speaker Interpreter
Cued Speech Practitioner
Sign Language Interpreter
Live Captioner
Gesturer
Whisper Intepreter
Transcriber
Visual Sketcher
Lip Reader
Emergency and Afterhours Assisted Communication
Needs Assessment
Note Taker
Other
LifeStyle Support Services
Medical
Police
Interview
Legal
Dispute
Social/Recreational
Work/Formal Event
Select Appropriate Scenario
Venue
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
-
Month
-
Day
Year
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Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Material Adaptation and Support Services
Tick Required Service(s)
Alternative Communication Material Development
Personalised Material Adaptation
Visual Adaptation,Video Subtitling,Captioning and Sign Language
Source Text Simplification
Transcription
Translation
Simple Document Editing(English, Afrikaans, Shona)
Training of Augmentative&Alternative Communication Facilitators
Deaf and deaf Culture sensitisation training/workshops
Needs Assessment
Research
Additional Information/Specific Requests
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