Interpreter Request Form

Interpreter Request Form

Please complete this form to request an interpreter for any appointment-related language assistance you may need. We provide language interpreter services for Colorado Access members enrolled in Health First Colorado Regions 3 & 5 and Child Health Plan Plus offered by Colorado Access. You can contact our customer service team at 800-511-5010 to confirm a member’s coverage. There is no fee for these services, and interpretation is a benefit of the members’ coverage. We require three business days advance notice to schedule an interpreter. If you need to cancel your interpreter after the appointment has been scheduled, we require two business days notice. If you have a preferred interpreter, we will try our best to assign your preferred interpreter; however, please note that it is not guaranteed.

Member ID number (a state ID):(Required)

Member Name(Required)

First Last

Date of Appointment(Required)

Date must be 72 business hours (3 days) from today to allow time for scheduling.

Time of Appointment(Required)

Duration of Appointment(Required)

Language(Required)

Preferred Interpreter

Preferrered Gender(Required)

Language(Required)

Requestor Name(Required)

Requestor Email Address(Required)

Interpretation type(Required)

Meeting ID(Required)

Meeting Passcode(Required)

Telehealth URL(Required)

Name of Appointment Location (e.g. member's home, provider's office, etc.)(Required)

Appointment address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you the member or the provider?(Required)

Appointment Type(Required)

Appointment department, what floor/building name(Required)

Provider's contact person's name(Required)

Provider's contact person's phone number(Required)

If you have questions, please contact our customer service team at 800-511-5010 or by email at interpreter.requests@coccess.com. Our hours of operation are Monday to Friday, from 8:00 a.m. to 5:00 p.m.