Join the Sapphire Circle at Swedish Hospital!

Thank you for your interest in Swedish Hospital's Sapphire Circle Club for people aged 60+ residing in the Swedish Hospital community. Sign up to join us for in-person programs and other special events. Membership also includes benefits such as discounts at the Chill Café, Starbucks inside Galter Medical Pavilion and the Galter Life Center.

Please complete this form to register for the Sapphire Circle. Must be at least 60 years of age to join.

If you have questions, please call 773-878-6888, ext. 3.

Question Title

* 1. First name

Question Title

* 2. Last name

Question Title

* 3. Gender

Female

Male

Other (specify)

Question Title

* 4. Street Address

Question Title

* 5. City

Question Title

* 6. State

Question Title

* 7. Zip Code

Question Title

* 8. Phone number

Question Title

* 9. Email address

Question Title

* 10. Date of birth

Month/Day/Year

Date

Question Title

* 11. We want to build this program around our community’s preferences! Please indicate what health and lifestyle topics you are interested in (select all that apply):

Stroke prevention

Heart health

Tech assistance accessing Telehealth

Skin care

Assistance using other technology

Long-term care

Nutrition

Journaling

Back pain

Cooking demonstrations

Advanced directives

Tech assistance accessing NorthShoreConnect

Medication management

Medicare options

Mental health support

Physical activity/exercise offerings

Falls prevention

Cancer prevention

Other (please specify)

Question Title

* 12. What other offerings are you interested in (select all that apply):

Volunteer opportunities at the hospital

Gardening

Special themed-dinner nights

Help navigating healthcare system (billing, appointments)

Social outings

Game nights

Intergenerational activities (bringing together younger and older people)

Other (please specify)

Join the Sapphire Circle at Swedish Hospital!

Question Title

* 1. First name

Question Title

* 2. Last name

Question Title

* 3. Gender

Question Title

* 4. Street Address

Question Title

* 5. City

Question Title

* 6. State

Question Title

* 7. Zip Code

Question Title

* 8. Phone number

Question Title

* 9. Email address

Question Title

* 10. Date of birth

Question Title

* 11. We want to build this program around our community’s preferences! Please indicate what health and lifestyle topics you are interested in (select all that apply):

Question Title

* 12. What other offerings are you interested in (select all that apply):

Question Title

* 13. Please share any other suggestions or feedback you’d like to provide.