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 630-527-6363.

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1. First name (Required.)

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2. Last name (Required.)

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3. Gender (Required.)

Female

Male

Other (specify)

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4. Street Address (Required.)

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5. City (Required.)

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6. State (Required.)

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7. Zip Code (Required.)

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8. Phone number (Required.)

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9. Email address (Required.)

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10. Date of birth (Required.)

Month/Day/Year

Date

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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): (Required.)

Skin care

Assistance using other technology

Nutrition

Journaling

Back pain

Medication management

Cancer prevention

Medicare options

Heart health

Tech assistance accessing NorthShoreConnect

Cooking demonstrations

Tech assistance accessing Telehealth

Physical activity/exercise offerings

Stroke prevention

Advanced directives

Mental health support

Falls prevention

Long-term care

Other (please specify)

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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 (Required.)

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* 2. Last name (Required.)

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* 3. Gender (Required.)

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* 4. Street Address (Required.)

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* 5. City (Required.)

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* 6. State (Required.)

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* 7. Zip Code (Required.)

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* 8. Phone number (Required.)

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* 9. Email address (Required.)

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* 10. Date of birth (Required.)

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* 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): (Required.)

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

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

1. First name (Required.)

2. Last name (Required.)

3. Gender (Required.)

4. Street Address (Required.)

5. City (Required.)

6. State (Required.)

7. Zip Code (Required.)

8. Phone number (Required.)

9. Email address (Required.)

10. Date of birth (Required.)

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): (Required.)

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

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