Henry ford authorization form 2026

1. Click ‘Get Form’ to open the Henry Ford Authorization Form in the editor.
2. Begin by filling out the Patient Information section. Enter your full name, including any previous last names, current address, city, state, zip code, date of birth, and phone number.
3. In the next section, specify which medical records you wish to access or release by checking the appropriate boxes for each facility listed.
4. Provide details about the recipient of the information in the Release Information section. Include their name, phone number, address, and fax number.
5. Indicate any specific services or types of records you want to include by checking the relevant boxes and providing descriptions and dates of service where applicable.
6. Sign and date the form at the bottom. Ensure that you also indicate your relationship to the patient if applicable.

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