Enrollment form

By submitting this form, you agree to the It’s Your Life service terms.

*Henry Ford Health System employee It's Your Life service terms.

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Authentication - This is your electronic signature that you agree to enroll in the program and you understand the program requirements as linked to above.
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If you are having symptoms of COVID-19, for your safety, please select a MyChart video visit on demand or call your primary care provider. For symptoms of COVID-19, please visit our website www.henryford.com/coronavirus.

Henry Ford Health System is committed to ensuring our Deaf or hard-of-hearing patients and visitors have equal access to all services. We provide the appropriate auxiliary aids and services, including qualified sign language interpreters, TTYs and other assistive listening devices, at no cost. To request assistance, call 313-916-1896 or email [email protected].

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