Patient Forms

Patient Forms

 

Preparing For Your Visit


 

 

 

We are excited to partner with you around your female healthcare needs!

 

 

 

 

 

To expedite registration, please arrive early to your appointment with the following paperwork fully complete.

 

This will give us the information we need to take the best possible care of you.

 

 

 

 
 

Select the option that describes you:

 

 

For additional assistance, please call (425) 313-7080 Monday - Friday 8 a.m. to 5 p.m.


 

Forms for New Patients

Please arrive at least 20 minutes prior to your scheduled appointment time.

  1. Registration Form
  2. MyChart Access Agreement (used to establish online access to your health information via MyChart)
  3. New Patient Intake Form
  4. Family History Request
  5. Authorization for Disclosure of Health Information (used to transfer medical records from an outside facility)
  6. Patient FMLA Paperwork Request

If you are coming to us from a provider outside of Swedish, it is helpful for your physician to have copies of the following from your previous or referring provider:

  • Your most recent health history and physical
  • Your most recent diagnostic studies (pap or other relevant gynecological tests)
  • Any operative reports
  • Any imaging reports

Expecting mothers should fill out this form along with any new or established patient paperwork.

  1. Prenatal Health Questionnaire

 

 

 

Forms for Established Patients

  1. Established Patient Annual Exam Form
  2. Registration Form (if it has been more than one year since your last visit)

There is no need to fill out additional paperwork, unless you have not yet signed up for MyChart.

MyChart Access Agreement (used to establish online access to your health information via MyChart) 


 

    Contact Information

    Swedish OB/GYN Ballard
    5350 Tallman Ave. N.W.
    Tallman Building, Suite 420
    Seattle, WA 98107
    Phone: 206-781-6161
    Fax: 206-781-6208
    Monday-Friday, 8:00 a.m.-5 p.m.
    Map & Directions