Enrollment forms
Use the links on this page to complete or print your enrollment forms. You can enroll at any time. If you have questions about the forms please contact us.
Steps to enroll in Seattle Premier Health:
1. Please read our privacy policy.
2. Print and complete the following forms.
- Patient Registration (PDF)
- Patient Profile (PDF)
- Notice of Privacy Practices Acknowledgment (PDF)
- Authorization of Disclosure of Health Information (PDF)
- For Medicare Beneficiaries only: Contract With Medicare Beneficiaries (PDF)
3. When you have completed all the forms you may email them to , fax them to 206‑215‑4315, mail them to us or bring them by our office Monday-Friday between 8:30a.m. and 5:00p.m. No appointment is necessary to enroll.
Seattle Premier Health
1600 E. Jefferson Street, Suite 115
Seattle, WA 98122
206-215-4300 (phone)
206-215-4315 (fax)
1600 E. Jefferson Street, Suite 115
Seattle, WA 98122
206-215-4300 (phone)
206-215-4315 (fax)
