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Medical Care


Patients & Visitors




About Holy Name Medical Center About Holy Name Medical Center

Key Phone Numbers

  • Medical Center Operator

  • 201-833-3000

  • Physician Referral Service

  • 877-HOLY-NAME (465-9626)

  • Patient Information

  • 201-833-3300

  • Foundation (Donations)

  • 201-833-3187

  • Human Resources

  • 201-833-7040

  • Medical Staff Office

  • 201-833-3352

View All Department Contact Numbers

For general questions or comments, email info@holyname.org


Appointment Requests

For More Information:

201-833-3085
Center for Rehabilitation

physicalrehab@holyname.org

Schedule a Therapy


Patient Information * Indicates required information
First Name: *



Last Name: *



Date of Birth: *

 
Email Address: *



Day Time Phone (M-F): *

- -
Preferred Contact Method: *

 Email        Phone
Clinical Information * Indicates required information
Therapy Type: *


Referring Physician: *


Insurance Plan Name: *



Have you had a therapy before? *

Yes       No

 
If so, please indicate type of therapy, where, when?



 
Comments or Questions:



 
Scheduling Preference Information * Indicates required information
Please indicate your appointment location preference: *

 
Please indicate your appointment date and time preferences:

First Preference Day:

First Preference Time Range:

 
Second Preference Day:

Second Preference Time Range:

 
Third Preference Day:

Third Preference Time Range:

 
Please note: This online request form will not officially book your appointment at Holy Name Medical Center. You will receive a call back and/or an email to schedule the actual date and time within 48 business hours from your request.