Customer Profile - Georgia Relay

1. Customer Information

Phone *

Additional Phone Numbers

Used by caller when contacting Rhode Island Relay

Additional Phone #1

Additional Phone #2 *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email Address *

Please indicate the best way to contact you *

Fax Number

Mailing List Signup

Please include me on the Rhode Island Relay mailing list.oice
Please include me on the Hamilton Relay mailing list.

2. Multi-User Profile/Remote Profile

Password + Personal Identification Number (PIN)

The multi-user/remote feature is of great benefit if you have more than one relay user living in your household or if you are away from your primary phone number. The Password and PIN ensures that you are the only person who can make changes to your profile. When accessing your profile from another location (remotely), please provide the CA with your 7-digit Password (alphanumeric) and 4-digit PIN (secret number) so the CA can access your profile options.

Password *

Password

Confirm Password

Choose 7 letters and/or numbers for Password

Pin *

Choose 4 numbers for PIN

3a. Making Relay Calls

Every time I CALL Relay, I use…

Language

English
Spanish

Call Type

Voice User choice

I am a voice user who wants to call a CapTel user.

When available, I prefer the gender of the CA relaying my call to be:

Male
Female
Either

3b. Answering Relay Calls

lives differently

Do you live with a person who answers Relay differently than you?

Every time I ANSWER a Relay call, I use

Language

English
Spanish

Call Type

4. For every Relay call I make, I want…

Check the service you want with EVERY relay call you make.

Text appears on screen beginning at 10 wpm and may be increased in increments of 5 up to 45 words per minute.

5. Speech-to-Speech (STS) Relay Connections

STS?

Do you use STS?

I want the CA to repeat everything I say:

I want the CA to repeat everything I say:

I want the CA to repeat everything I say:

Let the other person hear me
Don’t let the other person hear me

CA assist as needed by other party:

CA assist as needed by other party:

CA assist as needed by other party:

Automatically
When requested by either party

I want the CA to retain specific call content information from calls I make to use for making consecutive calls.

I want the CA to retain specific call content information from calls I make to use for making consecutive calls.

I use a Voice Synthesizer and/or Augmentative and Alternative Communication (AAC) device.

I use a Voice Synthesizer and/or Augmentative and Alternative Communication (AAC) device.

identify or describe your brand. You may also include notes for the CA on how to best work with you when you use your device.

I want the CA to confirm call handling preferences before dialing my requested number.

I want the CA to confirm call handling preferences before dialing my requested number.

I give permission for callers to request to call me by name rather than by telephone number.

I give permission for callers to request to call me by name rather than by telephone number.

Example: The person calling you can tell the CA “I’d like to call Bob Smith.”

How do you want to be listed in the directory?

available, me confirm

Standard First Instructions that I would like the CA to ask me on every call:

Example: Before dialing, I want the CA to ask “Shall I inform the other party who is calling?”

Standard Message for CAs to Leave on Answering Machines:

Example: “Hi, this is Bob. Please call me back through STS Relay at 877-735-1007 and ask the CA to dial my number 123-555-4567.”

Please indicate the best time to contact you at the number listed on Section 1:

If you have another number you would like to profile (such as a work number), please complete another form with the customized profile options you would like to be used for that number.

6. Long Distance Company

To prevent unnecessary long distance charges, please select the long distance company you use.

My long distance company is:

7. Speed Dialing

You may save up to 50 speed dial numbers. Be sure to include the area code with the phone number.

If you are a Speech-to-Speech (STS) user, please check the box if the person is already familiar with STS.

Name

Phone

STS

Familiar with STS

Name

Phone

STS

Familiar with STS

Name

Phone

STS

Familiar with STS

Name

Phone

STS

Familiar with STS

8. Greetings

I want CAs to say my first name to the people I call.

I want CAs to say my first name to the people I call.

Example: “This is Rhode Island Relay CA #4444 with a call from Bob.”

Name:

I want CAs to tell the people I call that

I want CAs to tell the people I call that: I…

Example: “This is Rhode Island Relay CA #4444 with a call from a person who has difficulty speaking.”

I am

I am deaf
I am hard of hearing
I have difficulty speaking
I am DeafBlind

Never Explain (NE)

Never Explain (NE)

Never explain how to use the relay to any person I call.

Use my Hello

Use “My Hello” when CAs greet me.

Example: “Hi, Bob here. How are you?”

CAs will greet the people you call this way:

Example: “Hi, Bob here. How are you?”

9. Restrictions

If you do not want to incur extra charges to your phone bill, indicate the types of calls on the list below that you do NOT want to be placed through Relay.

Restrictions

900/976/800
International
Directory Assistance
Operator Assistance

10. Notes

Provide any additional call handling instructions or information for the CA here:

You’re Almost Finished!

Thank you for completing your Rhode Island Relay Customer Profile. If you have any questions about your Profile, please contact Customer Care. To print a copy of this form for your records, go to the File menu of your browser and select Print before submitting the form. Your Customer Profile should be activated within 24-72 hours of receipt. All customer information is kept confidential. If you are satisfied with your Profile and ready to submit your information, click on Complete My Profile below.