You can open and print any of the following forms to complete and return to your clinic in person or by fax or mail:

• Pediatric Registration (used at your child's first appointment)
• Medical History (used at first appointment)
• Authorization for Disclosure of Health Information (used to release your records to or from another office)
• Permission To Treat a Minor (used when a child under age 18 goes to the doctor without parent or guardian)
• Permission to Treat a Minor when Accompanied by Non-Parent or Guardian (used to designate an adult other than the parent or guardian to give consent to medical or surgical treatment by any licensed physician or hospital)

Pediatric Gastroenterology Intake Forms

• Medical History (child 2 years +)
• Medical History (child under 2 years old)

Refer your pediatric patients to Swedish is simple: 

1. Submit a Request

• If you are on Epic: Type in “SMG PEDS” next to the “Refer To” line and select the specialty or simply type in the physician’s name.

2. We Schedule the Appointment

• We value the trust you place in us when you refer patients to Swedish; therefore, we establish a direct line of communication with you to keep you apprised of your patient’s progress.