Onsite Translation Services, Onsite Interpreting Services, Employment Interpreter

To expedite multiple requests for same person, check the boxes for services requested.

On-Site Telephonic Document Transportation

Requesting Party

First Name *

Last Name*

Phone Number *

(ex: 517-555-1234 x123)

Your E-mail Address *

Company

Title (Choose one)

Case Manager

Adjuster

Investigator

Payor Information

Payor's Company

Billing Street Address

City

State

Zip

(ex: 92101)

Payor's Phone

(ex: 517-555-1234 x123)

Adjuster on File - First Name

Adjuster on File - Last Name

Policy/Claim/Reference# *

Onsite Service Detail

Medical Appointment

Medical Legal (AME, DEF, QME, IME)

Statement

Employer-Employee Services

Deposition, Hearing or Trial

Meeting

Policy Holder Services

Requested Service Date(DOS)

(ex: mm-dd-yy)

Interpreter Arrival Time

(ex: 1:30pm)

Appointment Time

(ex: 1:30pm)

Expected Meeting Duration

(ex: 1:30pm)

Time Zone

Facility Name

Facility Street Address

City

State

Zip

(ex: 92101)

Facility Phone

(ex: 800-311-6289 x123)

Telephonic Service Detail

Benefit Explaination

Recorded Statement

Medical

Requested Service Date (DOS)

(ex: 01-01-11)

Requested Service Phone Number

(ex: 800-311-6289 x123)

Desired Meeting Time

(ex: 1:30pm)

Expected Meeting Duration

(ex: 1:30pm)

Time Zone

About the Limited English Speaker

First Name

Last Name

Language Spoken *

Primary Phone Number

(ex: 800-311-6289)

Claimant/Policy Holder Name (if different from above):

Work Phone (if applicable)

(ex: 800-311-6289 x123)

Employer (if applicable)

Date of Injury (DOI)

(ex: mm-dd-yy)

If the translation is need in less than 48 hours, please call in your request to
(800) 311-6289 to ensure scheduling.

Thank You,

Document Management Team

Option 1

Please use the following secure link to submit a document for translation.

One of our certified translators will reply to your request within the hour to discuss.

Option 2

Email your document to documents@3icorp.com.

Option 3

This Online Translation is provided as a free courtesy. The accuracy and outcomes of this translation are not the work or responsibility of 3iCorp.com.

Passenger Information

Passenger's First Name

Passenger's Last Name

Language Spoken *

Primary Phone *

(ex: 517-555-1234 x123)

Work Phone

(ex: 517-555-1234 x123)

Employer(if applicable)

Type of Coverage

(ex: Worker's Comp, Home,
Auto, Health, Other)

Date of Injury (DOI)

(ex: mm-dd-yy)

Height

(ex: 5'10")

Weight

(ex: 160 lbs)

Additional Message

We are known for our excellent customer service. Please let us know if there is anything else that we can do to better serve you.

Service Request

Requesting Party

Payor Information

Onsite Service Detail

Telephonic Service Detail

About the Limited English Speaker

Option 1

Option 2

Option 3

Passenger Information

Transportation Service Detail

Drop-Off Information

Special Instructions

Additional Message