Patient Forms

Please find below the forms available from our office for our patients' convenience. Kindly download the required form and bring it with you to your scheduled visit.

Welcome Letter

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Release of Patient Information Form

Authorization for Kitsap OBGYN, PLLC to request records from or send to another provider.
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Patient History Form

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Review of Systems Patient Questionnaire

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Insurance Consent / Privacy Form

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OB Genetic History Form

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Incyte Diagnostics Billing Information

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Breast Pump Resources

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Effective 9/1/2020: due to the time and medical expertise involved, Kitsap OBGYN, PLLC will charge a nominal fee for the completion of any forms (such as FMLA, disability, etc.). This will be charged based on the length of the form and collected prior to releasing the form. Please allow 7 business days to complete your form and we ask that you plan accordingly. It will be your responsibility to complete your portion of the form and return it to the appropriate institution.

Services We Recommend

Surgery Centers


20669 Bond Road NE, Suite 200
Poulsbo, WA 98370

Main Phone: 360-779-6527

Scheduling: 360-626-5266

Billing: 360-626-5260

Fax: 360-697-2743

Google Map


1800 NW Myhre Rd
Silverdale, WA 98383

Main Phone: 360-337-8800

Google Map

Imaging Centers


(several locations)

(360) 337-6500


(several locations)

(360) 598-3141


(several locations)

(425) 688-9274


(several locations)

(425) 646-0922


From Our Patients

Absolutely love this place, this is my second pregnancy at this clinic with provider Melanie Jenson, and I cannot say enough good things about her as well as the staff! The nurses as well as the providers are always so attentive and willing to answer any questions you have as well as going the extra mile. I’ve called multiple times with both pregnancies on their after hours lines and have always received a call immediately back and putting me at ease as well as having me come in the following day. Dr. Melanie provides 10/10 care and I recommend her to all expecting mothers. She makes every appointment enjoyable and makes sure I am always taken care of. Getting into the clinic was such a smooth process, they handled everything.

Love this clinic!  

Kimberly Heidenreich

January 21, 2023

My pregnancy journey was nothing short of amazing! Melanie Jensen was my midwife and made sure I was well taken care of and was thoroughly informed on everything that was going on. She always made me feel like if I had any questions I could openly ask.

Definitely recommend this practice!

Sarah Barbee

November 18, 2023

I recommend this office to anyone who will listen. Being newer to the area, I had to go through the annoying process of finding all new doctors and I’m so happy I went with Kitsap OBGYN. I’ve never felt rushed, treated like just another number or embarrassed to ask any questions.

Dr. Swenson was my primary physician for both my sons and each delivery was everything I wanted. At times, I was given the option to see the midwife on staff (forgot her name, sorry!) when my doctor wasn’t available and even those appointments were perfect.

After 2 pregnancies and almost 3 years of regular checkups, ending my child bearing journey was a little emotional. It’s not often you get such great care that you see your doctor and team as more than just medical care. I appreciate you all and special shoutout to Allison for being AWESOME! You made this period of my life one that I’ll always look back on fondly.

Alexandria Webster

January 14, 2024