Ford authorization any 2026

1. Click ‘Get Form’ to open the ford authorization any in the editor.
2. Begin by filling out the Patient Information section. Enter your full name, maiden name or previous names, address, date of birth, city, state, zip code, and phone number. If applicable, include your email address.
3. In the section authorizing records to be sent from Henry Ford Health System, select the appropriate facilities by checking the corresponding boxes.
4. Indicate where you want your records sent by selecting options such as MyChart, email, or mail. Provide additional details if necessary.
5. If you wish to include specific medical records or services, check the relevant boxes and provide details about the type of record requested.
6. Review the authorization statement carefully before signing. Ensure all information is accurate and complete.
7. Finally, sign and date the form at the bottom. If applicable, indicate your relationship to the patient.

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