Sign Up

This form should be completed to request a Henry Ford MyChart account for yourself. You must be at least 18 years old to complete online verification. Do NOT use this form to activate another family member’s account.

Please complete the form below. Henry Ford Health and its affiliates use Experian, a third-party verification system to confirm your identity. The information used for these questions is based on information from Experian. This information is not shared with Henry Ford Health and its affiliates but is used for third party identification verification.

Once verified, you will be able to immediately activate your account. If you have questions, please call customer service at 313-876-7951 and select MyChart account from the menu.

If you are attempting to gain proxy access to another account, you must first activate a MyChart account for yourself. Once your account is activated, log into your personal account and complete the appropriate form(s) from the “Other Accounts” menu. Access to others accounts is strictly controlled and only granted with appropriate authorization and consent forms (as applicable) on file. Click here for information about requesting access to other accounts.

Name

Address

Other information

Legal sex

I agree that by clicking the “Agree and Continue” button I have read this notice and I am providing ‘written instructions’ to Henry Ford Health and its affiliates under the Fair Credit Reporting Act authorizing Henry Ford Health to obtain information from my personal credit profile or other information from Experian (identity verification software). I authorize Henry Ford and its affiliates to obtain such information solely to confirm my identity prior to activation of a MyChart account in my name.