APPOINTMENT RECORD

Section A
Contact Details: (Completed by Agency or Interpreter when taking over phone) BILCS Auth.
No:....................................

Session Address: Patient’ Name:

……………………………………………………
………………………...
Date Required:
……………………………………………… ……………………………………………………
Appointment Time:…………………………………………….
.
Duration: ………………………………………………………..
……………………………………………… Section B
Interpreter/Agency Details : To be completed by the Interpreter

Interpreter’s Name:……………………………….. Language: …………………………………

Arrival Time:……………………………...............

Interpreting Start Time:...................................... Finish Time:

………………………………..
I declare that the information provided above is correct, I understand that if I give
information that is incorrect or incomplete, action may be taken against me.
Section C
To be completed by: NHS Personnel Only** (all details must be filled)
Name/ Position:………………………………..…….. Signature:…………………………………………..…….
Date:………………….……Tel:…………………..….. Interpreting Start Time:…………………Time out:…………
Appointment Time:……………………..…………… Name of Patient:…………………………………………
Extended Time …………..………………………….. Confirmed/BILCS Staff:………………………..…..…..
**NOTE: It is a BILCS requirement that if extra time is required beyond the additional 30 minutes from the
allotted time. YOU MUST inform BILCS on their contact number below. You need to write the name of the person
dealing with the enquiry below. Without the proper authorisation the interpreter has been instructed not to
proceed with the appointment and to get their timesheet signed and leave.

NHS PERSONNEL - PLEASE COMPLETE – (Under NO Circumstances Should An Interpreter

Complete This
Section)
How would you rate the quality of the interpreter BILCS Auth. Code
………………
Excellent Good Fair Poor
Comments:………………………………………………………………………………………………………………………
Should you prefer to send your comments directly to BILCS, please cut this comment section
from the bottom of the timesheet and return it, ENSURING YOU FILL IN THE BILCS
AUTHORISATION CODE to BILCS, address above. Alternatively you can speak to us on 0121 411
0470. Thank you, your feedback is valued.

Please return completed timesheets to:- timesheets@atozinterpreting.com

enquiries@atozinterpreting.com
www.atozinterpreting.com
Tel 0044-121 249 1933
Out-of-Hours: 0044-7739637807
15 Wellington Road, Edgbaston, Birmingham, B15 2EU