Luminis Request Form

For Billing Purposes, Which Luminis Health Division are You Placing a Request Under? *

Anne Arundel Medical Center
Clinical Enterprise
Doctors Community Medical Center
J Kent McNew Family Medical Center
Imaging Department

Please select only the department you are authorized to make requests for. If your department is not listed above, please contact info@slusa.com to get your department added.

What Type of Service do You Need? *

Sign Language (ASL) Interpreter
Foreign Language (Spanish, French, etc) Interpreter

Would You Like the Interpreter In-Person at Your Location or Virtual (Virtual does not mean On-demand VRI) *

In-Person
Virtual (tele-medicine, Zoom, Google Meets, etc)

Location of Appointment (We Need This Even for Virtual Requests) *

Address Line 1

Address Line 2

City

State

Zip Code

Department *

Your name (First and Last Required) *

Email *

Phone Number Where You Can Be Reached *

It is important we are able to contact you by phone or email with any questions about your request.

Appointment Date / Start Time *

Date

Time

End Time (estimate if you don't know the exact end time) *

Time Zone *

What Language Are You Requesting? *

Do you Prefer a Gender for the Interpreter? *

Female
Male
No Preference

Please Briefly Describe the Appointment So We Know What to Expect *

Is this a Radiology Appointment *

Yes
No

Which Radiology Specialty *

Breast Biopsy
CT Scan
Mammography
MRI
Ultrasound
X-Ray
Other

Arrival Instructions for the Interpreter Such as Parking Expectations, Point of Contact, Where to Check-in, etc

Please provide any helpful information. Remember the Interpreter has likely never been to your location. Names, Phone numbers, and parking expectations are all appreciated.

Patient or Person's Name Needing Interpreting *

If there are multiple people, simply type (group) or the best possible description

Medical Record Number *

Special Language Request?

Does this person require a CDI, Tactile, Pro-Tactile, or other specialty type of interpreting?

If This is a Recuring Appointment, Please enter additional Dates, Start/End Times. ONLY IF THE LOCATION IS THE SAME

Will You Provide a Link for the Interpreter to Join? *

Yes, I will Provide a Link to Our Appintment/Meeting
No. I Would Like SLUSA to Provide Me a Link and We Will Join the Interpreter

Please Enter the Link to Your Virtual Appointment *

If you do not have the link ready at this time, please enter “I will provide the link closer to the appointment date”

Learn About Our Services

In Person Interpreting

CART Captioning/Transcription

Virtual Interpreting

On-Demand Interpreting

Document Translation

In Person Interpreting

Virtual Interpreting

On Demand Interpreting

Document Translation

CART Captioning & Transcription