Enrollment Forms
Use the links on this page to print your enrollment forms. You can enroll at any time. If you have questions about the forms please contact us.
Steps to enroll in Swedish Community Health Medical Home:
1. Please read our privacy policy. See the Notice of Health Information Practices in your language of preference here.
2. Print and complete the following forms.
- Patient Registration
- Enrollment Form
- Medical History for Adults
- Medical History for Teens (ages 11-18)
- Medical History for Children (ages birth-10)
- Authorization of Disclosure of Health Information
3. When you completed all the forms you can fax them to 206-297-5151, mail them to us or bring them by the office Monday through Friday, between 8 a.m. and 5 p.m. No appointment is necessary to enroll.
Swedish Community Health Medical Home
Swedish/Ballard Campus
5300 Tallman Ave. N.W., 4-East
Seattle, WA 98107
206-297-5100 (phone)
206-297-5151 (fax)
communityhealthballard@swedish.org
Contact Information
Swedish Community Health Medical Home
5300 Tallman Ave. N.W.Seattle, WA 98107
Phone: 206-297-5100
Fax: 206-297-5151
Monday-Friday, 8 a.m.-5 p.m.
Map & Directions
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Patient Resources
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MyChart
You can view your Swedish medical chart, receive test results, schedule appointments online and more.
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