Optum Face-to-Face Interpretation Request Page

Face-to-Face Interpretation Request Form

Please use this form to request an in-person or remote video interpreter for Optum CalOptima and Medicare MSSP ACO patients only.

For all other health plan patients, contact their Full-Service Health Plan to coordinate an interpreter through the plan’s Language Assistance Program (LAP).
Request an ASL interpreter for all Optum patients by using this form, or connect directly to a remote video ASL interpreter at VoyceGlobal.com.

For all other health plans, refer to the Language Assistance Resource Guide.

Note: This form is only supported in the Chrome, Microsoft Edge, and Firefox browsers. If you receive any errors, please switch to a supported browser.

Patient Name (Last, First)*

Patient Gender

Patient Date of Birth*

Patient Health Plan Name*

HCP Region/Community/CA Super Region*

PCP Name (Last, First)*

PCP Network*

Language for interpretation*

Office Contact Name

Office Contact Phone*

Appointment Date

Appointment Start Time (include AM/PM)

Appointment End time (include AM/PM)

Appointment Location Address

Requester E-mail*

Requester Phone