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HCIN Scheduled Appointment Center:

New Request

Please complete this form to request an appointment for a language of lesser diffusion, or any circumstance in which you want advance confirmation that the best-matched interpreter will be ready for your provider and patient. This service is exclusively for authorized staff at Health Care Interpreter Network member organizations.


  • Scheduled appointments carry a 60-minute minimum charge. No-shows, late calls, and late cancellations are charged 60 minutes. See Terms and Conditions for details.


  • Fill in the form as completely as you can. Do not include patient identifiers such as name or DOB.
    Questions marked with a * must be completed. You do not need to sign in to Google.

  • Find and click the red "Submit" button at the bottom. You may need to scroll the form to see it.

  • Complete the Captcha security challenge (again, you may need to scroll the page to find it).

  • Look for an email confirming that the request has been received (check your spam folders).
    HCIN staff will contact you when your appointment is covered, or if we need additional information.

  • If your IT environment does not permit the use of Google Forms, you can submit your request by email.

  • To update or cancel the assignment, contact

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