Request A Room

Please read below before submitting a room request:

  • To be a guest at the Family House you must be traveling into Philadelphia from at least 25 miles away for a transplant appointment or treatment. If you are not a solid-organ transplant patient or family member or caregiver, you are not eligible to stay at the Family House. If you are unsure or have questions please contact us at 1-855-6-FAMILY.
  • If you are a solid-orgam transplant patient or family or caregiver traveling into Philadelphia for transplant-related treatment, please complete the following information and submit.
  • A representative from Gift of Life Family House will contact you regarding the status of the referral within 24 hours of receipt during normal business hours. If your room request is for anytime within the next 48 hours, DO NOT submit a Room Request online, please call our Guest Services Desk at 1-855-6-FAMILY.
  • Please read over our Infectious Disease Release prior to your requested check in date.

Due to the nature of the transplant process a referral is not a reservation and we cannot guarantee a room to a family prior to their requested arrival date.


* Required Fields
Do you live more than 25 miles away from the Family House?*
YesNo
Have you or another person related to the patient stayed at the Family House before?*
YesNo
Patient Name*
Patient DOB*
Patient Address*
Requested Check-in Date*
Transplant Hospital*
Children's Hospital of PhiladelphiaCrozer-Chester Medical Center
Einstein Medical CenterHahnemann University Hospital
Hospital of University of PennsylvaniaLankenau Medical Center
St. Christopher's Hospital for ChildrenTemple University Hospital
Thomas Jefferson University Hospital
Transplant Unit*
KidneyLiver
LungsHeart
Pancreas
Patient Status*
Transplant RecipientLiving Donor
Reason for Stay*
Pre-Transplant AppointmentTransplant Surgery
Post-Transplant AppointmentHospitalization
Appointment Date (if out-patient)
Guest Name (if different from patient)
Guest Primary Phone*
Guest Email Address*
Name of person completing form*
By clicking Yes, I the patient, authorize the release of Protected Health Information to Gift of Life Family House for the purpose of evaluating eligibility for lodging at their facility. I request that the transplant social worker of the transplant hospital or their designated representative disclose and release the above information, and any other information requested by Gift of Life Family House including, but not limited to: treatment dates and ongoing treatment requirements. You are authorized to release this information to the Gift of Life Family House social worker or their designated representative via telephone, facsimile, electronic mail, or standard mail. I understand that: (1) I have a right to revoke this authorization in writing at any time, except to the extent information has been released in reliance upon this authorization; (2) the information released in response to this authorization may be re-disclosed to other parties; (3) my treatment or payment for my treatment cannot be conditioned on the signing of this authorization.*
YesNo
Date*
Patient Name/relationship of legally auth. rep.*

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Organ Transplant Resources: Map, Hospitals, Groups & Trials

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Identify regional hospitals with organ transplant programs and support groups for transplant recipients and their families.

 
 

Caregiver LifeLine Program

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  • Online Caregiver Support Group for transplant caregivers to connect with other caregivers going through a similar situations
  • Education for transplant caregivers (improving physical and emotional health, & managing financial and employment issues)
  • Caregiver Resources, our Resource Handbook, and links to key website offering support for caregivers or addressing their issues. Resource of the Month: HelpHOPELive helps patients and families pay medical bills and access treatments by helping them organize tax-deductible fundraising efforts.