You are here:
Patient Info / Medical Records
We are happy to assist you with your medical record needs. At Bond Clinic , we have an Electronic Medical Records (or EMR) system that was implemented in late 2007.
To obtain copies of your medical records, you may contact Bond Clinic Medical Records at 863-293-1191, extension 3256, by fax at 863-299-0331, or you can to download the Release of Protected Health Information Authorization form. Please print and fill out completely and then fax to 863-299-0331.
When contacting the medical records department for copies of your medical records, please be prepared to provide them with the following information:
Patient Date of Birth
Name(s) of Bond Clinic Physician(s)
Date(s) of Service for records you are requesting
Name and Title of person to whom records are to be released
Address of person to whom records are to be released
Authorization signed by patient
(parent / responsible party in case of minor patient)
If you are requesting copies of records to be sent directly to another physician, there is no charge. However, there is a nominal charge (set by Florida Statute) for copies of medical records in all other circumstances, including patients requesting medical records due to the resignation of their physician.
If you have any questions or experience any problems, please contact us at email@example.com or by phone at 863-293-1191, ext. 3256.
Do you have a question that we haven’t answered on this website? Please feel free to contact us!
©2013 Bond Clinic, P.A. | 500 E. Central Avenue, Winter Haven, Florida 33880 | 863-293-1191 | firstname.lastname@example.org
Site Map | HIPAA Privacy Notice