Forms

Forms

Use the links below to access our Employer Referral Services forms.  The forms below can be submitted online or downloaded as indicated below.

Printable forms should be filled out and faxed to 206-320-2655. The Work Injury Emergency Room Referral form is not available for online submission.  It should be printed, filled out, and taken with you to a Swedish Emergency Room.

For more information or questions, please contact Laura Walden at laura.walden@swedish.org or 206-781-6008.


Employer Client Enrollment

 

 

 

 

Submit Online

or download and fax a printable form.


Employer Client Service Request and Treatment Authorization

download and fax a printable form.


Employer Work Injury Emergency Room Referral

Download the printable form.  You must take this filled out form with you when you visit the Swedish Emergency Room.


Employer Client Feedback

Submit Online

or download and fax a printable form.


 

Contact Information

Referral Services Team
1730 Minor Avenue
Metropolitan Park East Tower
Seattle, WA 98101
Fax: 206-320-2655
Email: referral@swedish.org