FHN » MyFHN

MyFHN Online Enrollment Form

Thank you for your interest in MyFHN, a web-based patient portal that provides you with secure and convenient access to your health information.

* Denotes required fields

* First Name

M.I.

* Last Name

* Verification Information

Either:
1. Your FHN primary care provider, OR
2. Name of an FHN provider seen in the last 30 days (approximate), OR
2. Date of an Emergency Room visit in the last 30 days (approximate).

* Date of Birth

mm/dd/yyyy

* Phone

* Mailing Address

Mailing Address Continued

*City

*State

Example: NY

*ZIP Code

Example: 12345

* Email

A valid email address is required in order to utilize MyFHN. Please provide a current, personal and private/non-shared email address to which only you have access and verify its accuracy. By providing an email address, you agree to have FHN communicate with you regarding MyFHN via email. Absolutely no protected health information will be included in any non-MyFHN email from FHN.

By checking this box, I acknowledge that I am requesting access to my health information in MyFHN. I understand that access to MyFHN will not expire unless I notify FHN in writing to discontinue it. I understand that the information in my health record may include information related to sexually transmitted disease or acquired immunodeficiency syndrome/human immunodeficiency virus. It may also include information related to behavioral or mental health services and treatment for alcohol/drug abuse if present in my record.

I hereby affirm that I am the patient identified above. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this application to access MyFHN.

Enrolling Minors

This online enrollment form cannot be used to enroll minors. If you like assistance in this, please check here and we will contact you using the information you provide above. Thank you.

* Signature
(please type in your full name)

Click Submit and you will be sent an email with a link to complete registration. Click on the link to create your own username and password, and choose a security question. Click "Log On" and enter your username and password to begin exploring MyFHN.

MyFHN Online Enrollment Form

Enrolling Minors

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MyFHN

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