Reservations

Returning Families Reservations

First visit families must have their reservation made by their NIH Social Worker.

For returning families, you may fill out the form below and press Submit to make your reservation. You will receive a call from The Inn a few days before your reservation date to confirm.

* required information Returning Family Reservations Form  Patient Information First Name:* Last Name:* Expected Departure Date: (mm/dd/yyyy) First Appointment Date: (mm/dd/yyyy) Anticipated Time of Arrival: Inn Arrival Date: (mm/dd/yyyy) Phone:* Business Phone: Cell Phone: Doctor's Telephone Number: Medical Service Telephone Number: Name of person accompanying: Relationship of accompanying person: Date of Birth of accompanying person (if under 18): Email Address of accompanying person: Is the patient taking medication?: Yes No Will the medication need refrigeration?: Yes No Is this visit for: Active Treatment Intensive care, surgery or crisis Is the patient: An in-patient (staying overnight at the Clinical Center) An out-patient (staying overnight at the Inn) Is the patient or any others in a wheelchair?: Yes No Prefer: Tub w/shower Handicapped accessible shower No preference Are there any special needs for any family member?: Yes No If yes, please explain: Type the characters you see in the picture below:*   Note: Due to the fragile health of many of our residents, we kindly request that you contact your medical team to reschedule your visit or make alternative housing accommodations if anyone traveling with you is experiencing cold, flu or stomach flu symptons or has been exposed to chicken pox. This form is for returning families only.