In order to obtain copies of your medical record, you must provide written, signed consent for release of records. The request can only be signed by the patient or legal representative after the date(s) of treatment. A copy can be downloaded by clicking on the link below or by calling us at (239) 624-6580 to receive a blank copy by mail or fax. Use the contact information below to send us a completed form either by fax or by mail. Patient’s can also come to the Central Campus @ 2157 Pine Ridge Rd, Naples FL to complete the release form or pick up the records. Please note that a picture ID must be presented and that coming onsite does not guarantee that medical record copies can be obtained that same day, please allow 1 – 2 days for preparation. There is no charge for records sent directly to your physician, but a charge of $1.00 per page applies otherwise.
If you need a copy of your birth certificate, this is filed with the state of Florida.  You may contact the County Court Clerk of Courts at 239-774-8205 or the Bureau of Vital Statistics, Jacksonville, FL., 904-359-6900 for a copy of your birth certificate. 

You can either mail or fax a completed form to:
Health Information Management
P.O. Box 8569
Naples, FL 34101-8569
tel: 239-624-6580
fax: 239-624-6561

We are located in the NCH Business Center at 2157 Pine Ridge Rd. (across from Home Depot and next to the White Elephant) in Naples. Our hours are Monday-Friday, 8:00 am to 5:00 pm.