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 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, 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.

Follow these steps to sign up for a MyChart account.

• Enter your personal information.
• Verify your contact information.
• Choose a username and password.

If you have any questions, please contact us at 313-876-7951.

Follow these steps to sign up for a MyChart account.

• Enter your personal information.
• Verify your identity.
• Choose a username and password.

If you have any questions, please contact us at 313-876-7951.

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.