Northwell ASL Interpreter Request Form

Northwell ASL Interpreter Request Form
Program: Northwell Health Vendor: SignTalk
PO#: SER-2676 Vendor ID: 47944

For after-hour requests (weeknights 7pm-7am, weekends & holidays),
please call 888-580-5519.

Interpreting Needs
Consumer Full Name*
Preferred Mode of Communication*

ASLPSECDITactile (Deaf Blind)Trilingual (specfiy language):
Number of Interpreters Needed*
Gender Preference (if any)
Job Description / Special Requests (ex: preferred interpreter)
To speak to a coordinator, dial 718-382-2020 and select option 1. For after-hours (weeknights 7pm-7am, weekends & holidays), please call 888-580-5519.
Should be Empty: