This form should be completed to request a Henry Ford MyChart account for yourself.
Do NOT use this form to request a code for another family member’s account or to request proxy access to another family member’s information.

We need some information from you in order to grant you a Henry Ford MyChart account. Once submitted, it may take 1-5 business days for processing and verification. Once approved, you will receive an email with your activation code and instructions on how to activate your MyChart account. If you have any questions or if you do not receive your activation code after 5 business days, call customer service at 1-800-HenryFord (436-7936).

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.

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We need some information in order to grant you a MyChart account. Enter your demographics here and in the next step we will verify your identity using questions from a third-party verification system. Once verified, you will receive an email or a letter with your activation code and instructions on how to activate your MyChart account. If you have any questions, please contact your clinic.

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First, we need to collect some information about the patient. If you have any questions, please contact your clinic.

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Now, we need to collect some information about you. Once we have this information, we will set up your appointment. If you have any questions, please contact your clinic.

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