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Thank you for visiting Einstein Healthcare Network’s website. Please complete and submit this appointment
request form or call 1-800-EINSTEIN, Monday – Friday, 8:30 AM – 5:00 PM. A referral representative will
contact you and help facilitate your appointment.
We look forward to assisting you with your healthcare needs. Please note:
our representatives do not have access to physician schedules and that submission
of this form does not guarantee an appointment.
Students must be enrolled in a LCME, COCA, ADA, CPME, or ARC-PA accredited school in good academic standing.
Students must apply for fourth year electives for the 2013-2014 academic year using Visiting Student Application Service (VSAS). All approvals and scheduling will be entered in the VSAS website. Einstein will be accepting applications beginning March 4th. Please submit your elective request as early as possible but at least 30 days prior to your desired start date. There is no guarantee of placement at anytime.
PLEASE NOTE: Course descriptions for the 2014-2015 academic year will be available by the end of February 2014. We will begin to accept applications in March 2014.
Once accepted for a rotation, additional registration forms will be required for review and submission. These will include but are not limited to:
The following safety forms must be filled out and brought in with you to orientation:
Questions can be directed to the specific program’s coordinator or to:
Sandra Swint-JonesMedical Education AdministratorOffice of Academic Affairs5501 Old York Rd.Philadelphia, PA 19141Phone: (215) 456-4961Fax: (215) 456-3429E-mail:StudentLearner@einstein.edu