The Brooklyn Heart Center Cardiology, Cardiac Testing and Cardiac Catheterization Lab IF THIS IS AN EMERGENCY PLEASE CALL 911 (DO NOT BOOK OR REQUEST AN APPOINTMENT) Request a Brooklyn Heart Center Appointment To request an appointment or more information from our Brooklyn Heart Center Team, please complete the form below. After you submit this information, a TBHC representative will contact you by phone within two business days. We can also be reached at 718.250.8267 on business days from 9 am – 5 pm. Please note that we accept most major insurance plans, including Medicare and Medicaid. * indicates required field Patient's First Name * Patient's Last Name * Sex * Male Female Decline to Answer Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Existing Patient * Yes No Health Insurance * Address City State Zip Code * Email Address * Phone * Preferred Contact Time * Reason for Visit or Information Request *
