Henry ford medical form 2025

1. Click ‘Get Form’ to open the Henry Ford Medical Form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter your full name, maiden name (if applicable), address, date of birth, city, state, zip code, and phone number. Ensure all details are accurate for proper identification.
3. In the 'Authorization' section, select which Henry Ford Health System facility you are authorizing to release your records. Check all that apply.
4. Specify who will receive your records by selecting one of the options provided: MyChart patient portal, email, mail, on-site inspection, fax, or verbal communication. Fill in any additional required information.
5. If applicable, indicate if you want to include medical records for specific services such as Substance Use Disorder diagnosis and treatment or Psychotherapy Notes.
6. Finally, sign and date the form at the bottom. If you are signing on behalf of someone else, indicate your relationship and provide any necessary documentation.

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