Stanford MyHealth

Request a MyHealth Activation Code by Postal Mail

Please share some information about yourself.

Fill out and submit the form below.
After you click the Submit button a confirmation notice will be sent to the email address you provide. If you do not receive a confirmation within 4 hours, please try your submission again.
Within one week an activation letter with your MyHealth Access Code will be mailed to your home. If we cannot fulfill your request we will contact you at the email address you provided.
After you receive the activation letter, return to the MyHealth website and enter your Access Code to complete your registration.

You may request an account if you are a current patient of Stanford Health Care, are 18 years of age or older, and have a U.S. mailing address.

To request an account for a minor see MyHealth Proxy Information.

Fields marked with an asterisk (*) are required.

MEDICAL RECORD NUMBER(MRN)

FIRST NAME*

MIDDLE NAME

LAST NAME*

STREET ADDRESS LINE 1*

STREET ADDRESS LINE 2

CITY*

STATE

ZIP CODE*

COUNTRY*

HOME PHONE*

CELL PHONE

WORK PHONE

EMAIL ADDRESS*

VERIFY EMAIL ADDRESS*

GENDER*

DATE OF BIRTH*