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We're glad you're here. In order to get you registered and scheduled we will need to obtain some information from you. Required questions are for our medical records system and for billing purposes we need to collect this information. All other questions are optional.
If you’re not ready to register for an appointment now, or you would like to talk to the Pride patient navigator about the Pride Program or Einstein in general, please call Eliza (they/them) at 215-420-0989 or email lgbtq-pride@einstein.edu.
Please list their name, pronoun(s), contact information, and relationship to you.