Lodi Health


Please fill out this form as completely as possible to request access to your online health information.  Once you have submitted this request, you will receive an email from MyLodiHealth@lodihealth.org within 24-48 business hours.  The email will include instructions on how to complete your enrollment.

You may be contacted by a Lodi Health representative to confirm your identity or if there is a question regarding your request.

Proxy access to another patient’s information can be requested in person at Lodi Health in the Medical Records department.  The patient granting proxy access to their account must be present with a picture identification in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Public Law 104-191.  Proxy access granted to parents of a minor will have access to their child’s record until that child reaches age 12 according to California regulations.

All of the following information is needed to correctly identify you, the patient.

Required fields are marked with *

Today’s Date:*
Patient First Name:*
Patient Last Name:*
Date of Birth:*
Last 4 numbers of social security number:*
Mailing Address:*
Email Address:*
Phone Number:*
How did you find out about My Lodi Health?

This form will be securely routed to Lodi Health. If you have any questions about this enrollment request, please contact us at help@lodihealth.org .

By clicking submit, I verify that I am the patient above and all information is accurate.