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n <br />r.. <br />AN IM I%Pn PER REFERML SERVICE <br />Dear Customer: <br />Enclosed is a copy of LIFESIGNS' Policies and Procedures that apply to services <br />provided on an as- needed basis. <br />Please carefully read the enclosed Policies and Procedures and complete page 5. <br />This form must be completed and returned before services can be provided. <br />You may either fax or mail the completed forms. <br />Please note that we have enclosed an optional Interpreter Request Fax Form if <br />you wish to fax your request. The Interpreter Referral Specialists will contact <br />you to confirm that the request has been received and if an interpreter was <br />secured. <br />Because LIFFSIGNS strives to provide excellent service, we have enclosed an <br />optional survey to give you the opportunity to let us know how we're doing. <br />Please take a few moments to fill it out and fax or mail it to LIFESIGNS. <br />We appreciate the opportunity to provide excellent service to you. Please <br />contact the Interpreter Referral Specialists if you have any questions or concerns <br />at(323)550 -4210. <br />I i <br />1H l <br />Denise M. Madland <br />Director <br />EXHISi i A <br />LIFESICNS, INC ADMINISTRATIVE OFFICES: 2222 LAVERNA AVENUE. LOS ANmE5. <A 90041 (323) 550 -4210 TTY /V (323) 5F' <br />StRviNG LOS ANCELES KERN ORANGE VENTURA SANTA BARBARA SAN LUIS OBISPO RIVERSIDE SAN BERNARDINO COUNT' <br />