logoOrder MyPHD PHR

Use the form below to reserve your MyPHD PHR account!

First Name: [MM_Member_Data name=’firstName’]    Last Name: [MM_Member_Data name=’lastName’] 

Email: [MM_Member_Data name=’email’]

Enter these details from your Janie Appleseed member account in the appropriate fields below.

 YES! Reserve a MyPHD PHR in my name. I understand that the MyPHD Personal Health Record service is a digital computer application used to store and view personal health data over time. I would use this service to collect, review, and share data to inform present and future choices effecting my health and care.
 YES! I understand that I will have complete control over who has access to information stored in MyPHD and that all access to my information is governed by a Terms of Use agreement that will be written in plain language so it will be easy to read and understand.
 YES! I understand that the MyPHD Personal Health Record service may cost approximately $8.50 per month (or less) for the primary subscriber. Additional adults may be added to a family subscription for $7.50 per month per person or less depending on the number of adults added. Children may be added to a family subscription for $1.00 per month per child. Actual prices may vary at time of introduction. Introductory offers may apply. Sliding-scale pricing may be offered for families who qualify based on current income level.
 YES! Please contact me when the MyPHD Personal Health Record service becomes available.