Enrollment Information

FAQs Enrollment Forms
FAQs

You can print out, complete and sign the Enrollment Agreement form and bring it with you to your first visit, or you can fill it out at the clinic. Please bring your valid credit or debit card with your billing confirmation.

In signing the Enrollment Agreement, you agree to have us bill your credit or debit card automatically on the first day of each month for the previous month's enrollment fee.

No. One of the ways we are able to provide you with low cost health care is by eliminating complicated billing procedures. Automatic charges to your credit or debit card dramatically reduce costs for you.

Additionally, your monthly fee covers all your visits, phone calls and e-mail contacts as well as all tests done in the clinic.

Yes. When you sign up for our medical services you agree to pay on a monthly basis, whether or not you need our services that month. But there is no limit to how many visits you can have in a year. You and any enrolled family members may see your doctor as often as you need to, based on schedule availability.

While health insurance is not a requirement, we recommend that you obtain some form of standard or catastrophic insurance in the event that you require emergency room care, hospitalization, specialty or long-term care. Insurance may help pay for some of these costs.

If you are covered by Medicaid, Medicare or private insurance, it may not make sense to be in the program. However, if you have insurance with a high deductible (over $500/year) it could be beneficial as the SP Program costs approximately $660/year.

At times, your physician may refer you for tests or to see a specialist outside of our clinic. Though your monthly fee does not cover these services, we can provide you with a list of referral options, some of whom may offer discounted rates.

No. We do not provide comprehensive pregnancy care including preconception counseling, prenatal, labor and delivery, postpartum and newborn care under the program. Please contact our front desk staff to discuss other options for your pregnancy coverage.

Yes. Your children can be enrolled even if you are not enrolled. You would still need to provide a valid credit/debit card for the monthly fee.

You may qualify for Swedish financial help or state insurance. You can contact our Ballard Financial Counselors directly at 206-781-6065 for more information.

Upon signing the agreement, you agree to a minimum of six months, if after those six months, you choose to stop using the program you can do so with the Fam-Med-Cancellation-Form. This form can be completed and faxed to 206-297-5151, mailed to our address or dropped off directly to the front desk. Once you end your membership, you may not be able to re-enroll for six months.

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 become a patient at Swedish Family Medicine - Ballard

  1. Please read our privacy policy. See the Notice of Health Information Practices in your language of preference.
  2. Print and complete the following forms:
  3. When you have 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.