In-person Interpreter Services Request Form

Avid in-person interpreters should only be used for highly specialized situations. Providers can request services depending on the needs of specific clinical encounters as determined by the provider, such as:

  • Complex or life-threatening diagnosis news delivery
  • End-of-life discussions
  • Group sessions/meetings with multiple unrelated HPSM members

CLI’s video interpreters are available for those who need an ASL interpreter.

In-person interpreter availability is limited, so please let us know at least five business days before the appointment to ensure the interpreter can be scheduled. Cancellations require at least 48-hour notice to HPSM before the appointment request date. Please note that your request is not considered fulfilled until you receive a confirmation email from HPSM verifying that the interpreter has been scheduled. If you have questions about in-person interpreters, email interpreters@hpsm.org.

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Patient's Information

HPSM program enrollment:

Appointment information

Type of interpreter:
(i.e. list the treatments, types of procedures and/or specific health concerns to be addressed during this visit.)

Provider's information