{"id":38,"date":"2017-08-11T14:17:23","date_gmt":"2017-08-11T14:17:23","guid":{"rendered":"https:\/\/calilanguagesolutions.com\/?page_id=38"},"modified":"2024-09-12T21:45:57","modified_gmt":"2024-09-12T21:45:57","slug":"order-translation","status":"publish","type":"page","link":"https:\/\/calilanguagesolutions.com\/?page_id=38","title":{"rendered":"Schedule Interperter"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<div id=\"sc_title_92848139\"\n\t\tclass=\"sc_title color_style_default sc_title_default\"><h2 class=\"sc_item_title sc_title_title sc_align_center sc_item_title_style_default sc_item_title_tag\">Submitter Information<\/h2><\/div><!-- \/.sc_title -->[vc_empty_space height=&#8221;1em&#8221; alter_height=&#8221;none&#8221; hide_on_desktop=&#8221;&#8221; hide_on_notebook=&#8221;&#8221; hide_on_tablet=&#8221;&#8221; hide_on_mobile=&#8221;&#8221;][vc_empty_space height=&#8221;1.5em&#8221; alter_height=&#8221;none&#8221; hide_on_desktop=&#8221;&#8221; hide_on_notebook=&#8221;&#8221; hide_on_tablet=&#8221;&#8221; hide_on_mobile=&#8221;1&#8243;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1650-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1650\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F38#wpcf7-f1650-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1650\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1650-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><h5>Your Contact Information<\/h5><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-261\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name *\" value=\"\" type=\"text\" name=\"text-261\" \/><\/span><\/div><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-988\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name *\" value=\"\" type=\"text\" name=\"text-988\" \/><\/span><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-710\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Company Name\" value=\"\" type=\"text\" name=\"text-710\" \/><\/span><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tel-759\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone\" value=\"\" type=\"tel\" name=\"tel-759\" \/><\/span><\/div><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"email-501\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email *\" value=\"\" type=\"email\" name=\"email-501\" \/><\/span><\/div><\/div>\n\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><h5>Claimant Details<\/h5><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-261\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Claimant First Name *\" value=\"\" type=\"text\" name=\"text-261\" \/><\/span><\/div><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-988\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Claimant Last Name *\" value=\"\" type=\"text\" name=\"text-988\" \/><\/span><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tel-759\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Claimant Phone\" value=\"\" type=\"tel\" name=\"tel-759\" \/><\/span><\/div><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-105\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-105\"><option value=\"Appointment Type *\">Appointment Type *<\/option><option value=\"Physician\">Physician<\/option><option value=\"Medical Facility\">Medical Facility<\/option><option value=\"Surgical\">Surgical<\/option><option value=\"Independent Medical Evaluation\">Independent Medical Evaluation<\/option><\/select><\/span><\/div><\/div>\n\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><h5>Select Appointment Date & Time <\/h6><\/div><\/div><span class=\"wpcf7-form-control-wrap\" data-name=\"date-100\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2024-09-12\" max=\"2025-09-12\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"yyyy-mm-dd\" value=\"\" type=\"date\" name=\"date-100\" \/><\/span><label>\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-384\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Appointment Time\" value=\"\" type=\"text\" name=\"text-384\" \/><\/span><\/div><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-384\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Approximate Appointment Duration\" value=\"\" type=\"text\" name=\"text-384\" \/><\/span><\/div><\/div>\n\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><h5>Appointment Details<\/h5><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-432\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Healthcare Facility Name\" value=\"\" type=\"text\" name=\"text-432\" \/><\/span><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-432\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Healthcare Facility Address\" value=\"\" type=\"text\" name=\"text-432\" \/><\/span><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-432\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"State\" value=\"\" type=\"text\" name=\"text-432\" \/><\/span><\/div><\/div<div class=\"columns_wrap\"><div class=\"column-1_2\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-432\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Zip Code\" value=\"\" type=\"text\" name=\"text-432\" \/><\/span><\/div><\/div>\n\n<div class=\"columns_wrap\"><div class=\"column-1_2\"><h5>Source Language<\/h5><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-930\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-930\"><option value=\"Source Language *\">Source Language *<\/option><option value=\"English\">English<\/option><option value=\"French\">French<\/option><option value=\"German\">German<\/option><option value=\"Creole\">Creole<\/option><option value=\"Spanish\">Spanish<\/option><option value=\"Russian\">Russian<\/option><option value=\"Chinese\">Chinese<\/option><\/select><\/span><\/div><div class=\"column-1_2\"><h5>Target Language<\/h5><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-166\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-166\"><option value=\"Target Language *\">Target Language *<\/option><option value=\"English\">English<\/option><option value=\"French\">French<\/option><option value=\"German\">German<\/option><option value=\"Creole\">Creole<\/option><option value=\"Spanish\">Spanish<\/option><option value=\"Russian\">Russian<\/option><option value=\"Chinese\">Chinese<\/option><\/select><\/span><\/div><\/div>\n\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><h5>Upload Supporting Documents<\/h5><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><span class=\"wpcf7-form-control-wrap\" data-name=\"file-515\"><span class=\"fileform\"><span class=\"selectbutton\">Select File<\/span><span id=\"fileformlabel\">Upload File<\/span><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\"audio\/*,video\/*,image\/*\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"file-515\" \/><\/span><\/span><\/div><\/div>\n\n\n<div class=\"columns_wrap\"><div class=\"column-1_1\"><h5>How to Contact You?<\/h5><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_1 extra\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-147\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-147\" value=\"Call me back\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Call me back<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-147\" value=\"No, contact me via e-mail\" \/><span class=\"wpcf7-list-item-label\">No, contact me via e-mail<\/span><\/label><\/span><\/span><\/span><\/div><\/div>\n<div class=\"columns_wrap\"><div class=\"column-1_1 center\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Email My Request\" \/><\/div><\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"123\"\/><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n\/* ]]> *\/\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_empty_space height=&#8221;1em&#8221; alter_height=&#8221;none&#8221; hide_on_desktop=&#8221;&#8221; hide_on_notebook=&#8221;&#8221; hide_on_tablet=&#8221;&#8221; hide_on_mobile=&#8221;&#8221;][vc_empty_space height=&#8221;1.5em&#8221; 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