Health & care 27 questions 3 pages About 9 min to fill in

Medical Interpreter Request Form

A three-page booking form for spoken and sign language interpreters at medical appointments, in person, by video or by phone.

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Medical interpreter request
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Use this template Every question, option and rule can be changed in the designer.

What is the medical interpreter request form template?

Patients who don't speak the clinic's language well, or who use sign language, need a professional interpreter to understand their care and give informed consent. Booking one means giving the interpreting service everything at once: the exact language or dialect, the appointment type and length, whether it's in person or remote, and any preference the patient has.

This template can be completed by clinic staff, the patient or a relative. It records who's asking, their department and contact details — with a cost centre for staff — then the patient, the type of interpreting (spoken, sign or deafblind), the language and dialect, any gender preference with an optional reason, a named interpreter the patient has used before and whether the patient knows one is being booked.

The appointment page records the date, start time, expected length, appointment type and whether sensitive topics will come up. In-person bookings ask where to go and where to report; video and phone bookings ask for the link or number. Repeat appointments can be listed. Each request is saved as a PDF in FileIt.

Best for
Hospitals, GP practices, clinics, community health services and interpreting coordinators
Filled in by
Clinic staff, the patient or a relative or carer
Time to complete
About 3 minutes
Includes
Spoken, sign and deafblind interpreting, language and dialect, gender preference, appointment type and length, in-person or remote details and repeat dates

Who uses a medical interpreter request form?

  • Outpatient clinics booking interpreters ahead of appointments
  • GP practices arranging interpreters for registered patients
  • Patients or families requesting an interpreter themselves
  • Booking sign language interpreters for Deaf patients
  • Maternity teams arranging interpreters for a series of antenatal visits
  • Mental health services booking interpreters for therapy sessions

Questions on this medical interpreter request form

27 questions over 3 pages · includes conditional questions, multiple pages.

1 Requester

  • Your name*
  • You are* Clinic or hospital staff · The patient · A relative or carer
  • Clinic, ward or department*
  • Phone*
  • Email*
  • Cost centre or budget code asked only when it applies

2 Patient & language

  • Patient name*
  • Patient ID or record number
  • Type of interpreting* Spoken language · Sign language · Deafblind interpreting
  • Language needed*
  • Dialect or regional variety
  • Interpreter gender preference* No preference · Female interpreter · Male interpreter
  • Reason, if you'd like to tell us asked only when it applies
  • Interpreter the patient has used before and would like again
  • Does the patient know an interpreter is being booked?

3 Appointment

  • Appointment date*
  • Start time*
  • Expected length* Up to 30 minutes · Up to 1 hour · Up to 2 hours · Half a day · Full day
  • Appointment type* Outpatient appointment · GP or primary care · Ward round or inpatient · Consent for a procedure · Test results or difficult news · Mental health · Maternity · Therapy session · Discharge planning · Other
  • Will sensitive topics be discussed?
  • How should the interpreter attend?* In person · Video · Telephone
  • Where to go* asked only when it applies
  • Where to report on arrival asked only when it applies
  • Video link or number to call asked only when it applies
  • Is this one of a series of appointments?
  • Other dates and times asked only when it applies
  • Anything else the interpreter should know

The medical interpreter request form, page by page

1 Requester

The requester gives their name, whether they're staff, the patient or a relative or carer, the clinic or department, phone and email. Staff can add a cost centre or budget code.

2 Patient & language

Record the patient's name and ID, then the type of interpreting — spoken, sign or deafblind — the language needed and any dialect or regional variety. A gender preference for the interpreter can be given, with an optional reason. There's room to name an interpreter the patient has used before and to note whether the patient knows one is being booked.

3 Appointment

Enter the date, start time and expected length, from up to 30 minutes to a full day, and the appointment type, such as consent for a procedure, test results, mental health or maternity. A question flags sensitive topics so the interpreter can prepare. Choose in person, video or telephone: in person asks where to go and where to report on arrival; remote asks for the link or number. Series of appointments can be listed, with notes for the interpreter.

Make the template yours

  • Add your interpreting service's notice periods to the cover text
  • Replace the language box with a dropdown of the languages your service covers
  • Send requests to your interpreting coordinator's inbox
  • Prefill the department with personal links for each clinic
  • Add a cancellation question if your service charges for late cancellations
  • File requests by department in separate vault folders

Tips for a better medical interpreter request form

  • Book as early as possible, especially for less common languages and sign language
  • Name the dialect — two speakers of the same language may not understand each other well
  • Allow extra time: interpreted appointments usually take longer
  • Avoid using family members, especially children, as interpreters
  • Brief the interpreter before sensitive conversations
  • Record the interpreter's name in the patient's notes after the appointment

Every response becomes a PDF in your vault

Each request is saved as a PDF in the vault folder you choose, and the account owner and any extra addresses, such as your interpreting coordinator, can be emailed as soon as it arrives. The requester can receive a copy.

In Responses, filter by date or language to plan bookings, or export to CSV to see demand by language and department.

  1. Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
  2. Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
  3. Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Use the medical interpreter request template — it’s free

Medical interpreter request form: frequently asked questions

Is this medical interpreter request template free?

Yes. It's part of the Forms app, included with every FileIt account, the free plan too.

Does FileIt book the interpreter?

No. The form collects the request and sends it to you or your interpreting coordinator, who books the interpreter in the usual way.

Can patients request an interpreter themselves?

Yes. The requester can be clinic staff, the patient or a relative or carer.

Does it cover sign language?

Yes. Choose sign language or deafblind interpreting and enter the sign language needed.

Can I book a series of appointments?

Yes. Answer yes to the series question and list the other dates and times.

Can I add the languages we offer as a list?

Yes. Replace the language text box with a dropdown in the designer.

Use this template — free