多文化通訳派遣「ことさぽ」お申し込み・ご相談フォーム_en
KOTOSAPO Application Form (Interpreter Dispatch Service)

Essential items to be filled
Name
Sex
Age
Address
Phone Number (Home)
 -  - 
Phone Number (Mobile)
 -  - 
Available time to receive phone-call (Office staff will call you for confirmation later.)
FAX Number
 -  - 
e-mail address

for confirmation
Mother Language

Please select.
Language for interpretation
Date and time for employment of interpreter(as far as you know)

Ex) Nov. 27, 10:00~12:00
Place to visit

Ex) ○○Hospital, City Government, Healthcare Center in Ward Sakyo, Kyoto, etc.
Purpose (Contents)

Ex) 3month medical check-up, want to put contact lenses, toothache (first visit), etc.
Where did you know our interpreter dispatch service?
Please write down if you have any questions.