Preferences - UCLA Health - Los Angeles, CA

Fill out this form to schedule an interpreter and please provide as much lead-time as possible. Interpreter availability cannot be guaranteed for requests made less than 48 business hours in advance.

NOTE: If you need an interpreter for a Zoom meeting or a MyChart Video Visit for a language other than Spanish or American Sign Language, or for Spanish after business hours, please do not fill out this form; instead, follow the instructions here.

Requester's First Name *

Requester's Last Name *

Requester's Email *

Requester's Phone Number/Extension *

Specific Location *

Department Name *

Street Address *

City *

State or Province *

Zip or Postal Code *

Transplant or Research? *

Yes

Service Recipient's First Name *

Patient will be onsite

Service Recipient's Last Name *

Service Recipient's Date of Birth *

MM/DD/YY or MM/DD/YYYY

Language *

Date of Appointment *

Time of Appointment *

Appointment Duration *

MRN # *

Type of Appointment *

5-Digit Department Code *

Urgent/critical SAME DAY requests require approval from the Language Services management team. Please call x78001 and select option 1 to speak with someone regarding your request.

Additional Information

For Example: Nature of appointment, facility number, etc.

I agree to receive communications from UCLA Health.

UCLA Health Interpreter Request