Forms

Release of Radiology Films


Attention: Please make sure you call at least 24 hours in advance prior to borrowing films. 
Any questions can be answered by calling the Radiology Release Line.
To efficiently process your request, please follow the following steps:

  1. Call the Radiology Release Line (239) 949-6105.
  2. The films will be located at the front desk of Bonita Community Health Center where you must sign a release form.

Release of Information Form


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:

PDF Format Microsoft Word Document

Patient Registration Form

For your convenience, please fill out this patient registration form ahead of time and bring it to your first visit.

Click to download the BCHC Patient Registration Form:

PDF Format Microsoft Word Document

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:

PDF Format Microsoft Word Document

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

lzadorecky@bonitahealthcenter.com Fax to Human Resources at Fax: (239) 949-6176

Or Mail to:

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

Volunteer Application Form

For your convenience, please fill out this patient registration form ahead of time and bring it to your first visit.

Click to download the BCHC Patient Registration Form:

PDF Format Microsoft Word Document

 

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