To request a copy of your medical records, please print and complete the Patient Information Release Authorization. The form must be completed in full - incomplete forms will be returned unprocessed.
The Patient Information Release Authorization should be signed and dated. Only the patient, the patient's legal guardian, the parent of a minor patient or the personal representative of a deceased patient may sign. If the patient is not signing, a copy of the Letters of Authority as Legal Guardian or as Personal Representative must accompany the form.
A separate authorization must be completed for each medical record request. Requests should be directed to the facility where care was delivered.
Henry Ford Hospital and Health Network Attn: Medical Records 2799 West Grand Blvd. Detroit, MI 48202
Henry Ford Cottage Hospital Attn: Medical Records 159 Kercheval Grosse Pointe Farms, MI 48236
Henry Ford Macomb Hospital - Clinton Campus Attn: Medical Records 15855 Nineteen Mile Road Clinton Township, MI 48038
Henry Ford Macomb Hospital - Warren Campus Attn: Medical Records 13355 East Ten Mile Road Warren, MI 48089
Henry Ford West Bloomfield Hospital Attn: Medical Records 6777 West Maple Road West Bloomfield, MI 48322
Henry Ford Wyandotte Hospital Attn: Medical Records/HIM Dept. 2333 Biddle Ave. Wyandotte, MI 48192
Looking for records from a hospital that later joined Henry Ford Health System?
