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seattlechildrens Sign Up Information

Last Updated:

5/20/2020

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Yes

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Email Address

Your Name

First Name, Last Name

Your Address

Home Address, City, State, Postcode

Phone Number

Phone

Post-Registration Data

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This site did not show evidence of storing passwords in plaintext.

This site does allow secured connections (https)

This site did show a clear way to unsubscribe from their emails

This site does verify your email address.

Membership Emails

Below is a sample of the emails you can expect to receive when signed up to seattlechildrens.

Thank you for your application...

Thank you for submitting your application for financial assistance.

For your reference, your application ID# is 61239. You submitted your application on 5/20/2020.

Decisions are made without regard to race, sex, creed, ethnicity, religion or other protected status of applicants.

A letter will be sent to the person who turned in the form within 14 days of receipt of the application.

The letter will say whether you are approved or denied.

The letter will also tell you the period of time that you qualify.

The information in the letter is shared with Children''s University Medical Group (CUMG) and Odessa Brown Children''s Clinic (OBCC). These places honor the decisions we make about financial assistance.

University of Washington Physicians (UWP) and Seattle Cancer Care Alliance (SCCA) also honor the decisions we make about financial assistance when services are provided at Seattle Children''s.

Raw Data Registration Structure Registration Form Text

Registration

SCREENING INFORMATION If we need to contact you for additional information, do you need an interpreter?*

First name

Last name

Phone

Home address

City

State

Postcode

Please select

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Please select

AGREEMENT I understand Seattle Children's Hospital may verify the information on this form and may use other sources to help determine if I am eligible for financial assistance or payment plans.

Data Name	Data Type	Options
SCREENING INFORMATION If we need to contact you for additional information, do you need an interpreter?*	Text Box
First name	Text Box
Last name	Text Box
Email	Text Box
Phone	Text Box
Home address	Text Box
City	Text Box
State	Text Box
Postcode	Text Box
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	checklist	Year2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900
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	checklist	AGREEMENT I understand Seattle Children's Hospital may verify the information on this form and may use other sources to help determine if I am eligible for financial assistance or payment plans.

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Comment on: 01/09/2020