Forms

Release of Radiology Images/CD

To efficiently process your request, please follow the following steps:

1. Mail the completed form with signature to the following address:
Attention: Radiology Dept.
Bonita Community Health Center
3501 Health Center Boulevard
Bonita Springs, FL 34135
2. Fax the completed form with signature to (239) 949-6175.
3. Bring the completed form with signature to the Radiology Department within Bonita Community Health Center.

Click to download the BCHC Release of Radiology Images/CD Form:

Release of Medical Records

Attention: This form must be signed in order for us to release copies of your medical records.
To efficiently process your request, please return the form in one of the following ways:

1. Mail the completed form with signature to the following address:
Attention: Medical Records
Bonita Community Health Center
3501 Health Center Boulevard
Bonita Springs, FL 34135
2. Fax the completed form with signature to (239) 949-6132.
3. Bring the completed form with signature to the front desk located at the entrance of the Bonita Community Health Center.

Click to download the BCHC Release of Information Form:

Application for Employment

If you are interested in working for the Bonita Community Health Center, please fill out and return to us the following Application for Employment.

Click to download the BCHC Application for Employment:

Please fax or e-mail your completed job application to:

Fax to Human Resources at Fax: (239) 949 6116

Or Mail to:

Human Resources
Bonita Community Health Center
3501 Health Center Boulevard
Bonita Springs, FL 34135


Volunteer Application Form

Patient Responsibilities

Patient's Bill of Rights

Privacy Notice

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