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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.
Einstein wants its patients to be informed and involved in their care.
We encourage you to prepare for your hospital stay, educate yourself about your rights and share questions and concerns.
Your privacy rights are protected under the Health Insurance Portability and Accountability Act, or HIPAA.
Einstein provides each patient with a Notice of Privacy Practices detailing how your information is used and disclosed.
For questions or concerns relating to your rights, contact:
Einstein Healthcare Network Privacy Office1000 W. Tabor RoadPhiladelphia, PA 19141
Telephone: (215) 456-3517Fax: (215) 456-3330E-mail: firstname.lastname@example.org
Additional information relating to privacy:
Summary of Privacy Practices This document gives you a brief overview of the federal privacy regulations and the steps that Einstein takes to protect your confidential information.
HIPAA / Privacy Forms These forms allow you to provide Einstein with special instructions on how you want your personal information used or shared with others.
How to Contact Einstein’s Privacy Office Einstein has established a Privacy Office to help address patients’ questions and concerns. Please refer here when you need assistance.