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Contact Us

Bolingbrook Christian Health Center
151 Briarcliff Road
Bolingbrook, IL 60440

Phone: 630-783-2832
Fax: 630-783-2837

Assistance

Pharmacy Assistance is provided (for BCHC clients) through individual pharmaceutical companies in order to help those who financially qualify to receive free medicine from the manufacturer.  This is determined through an application and evaluation of the previous year’s federal tax return 1040 or 1040EZ.  Patients may print off applications from the pharmaceutical company’s websites (listed below) by looking for the patient assistance area.  That form must be signed by our medical providers.  Our assistance team will go over it and then send it in for a review.  If you are accepted, in most cases you will receive four shipments containing three months of medicine.  This program requires reapplying each year.

Pharmaceutical Companies

 A B C
 
Abbott
Alcon
Allergan
All Kids
Amgen
ASAP, Inc.
Astellas
Astra Zeneca
Aventis
Bayer
BD
Bertek
Biovail
Boehringer Ingelheim
Bristol-Myers Squibb
Bridges to Access
Centocor
 D E F
Daiichi Sankyo, Inc. Endo Family Care
Forest
Fugisawa Healthcare, Inc.
G H I
Galderma Labs
Glaxo Smith Kline
Hill Dermatological, Inc. ICN
Ivax Labs
J K L
Janssen
Johnson and Johnson
Kid Cares Lilly Cares
Lederle
M N O
MedPointe Pharmaceuticals
Merck Crossroads
Merck: Vytorin and Zetia
Nono Nordisk
Novartis
Ortho – McNeil
P Q R S
Partnership for Prescription Assistance
Pfizer
Pharmacia
Proctor and Gamble
 RX Outreach Schering Plough Corporation
Sciele (1st Horizon)
Suboxone
T U V W X Y Z
Takeda
TAP Prevacid Program
Taxes
Teva
Together RX
Together RX – Medicare
UCB Pharms
Misc
 3M Pharmaceuticals

 


New Patient Forms

Please download each of the new patient forms and fill them in preparation for your first visit.

English Spanish
New Patient Information
Medical History
NO INSURANCE VERIFICATION
Privacy Practice Information
Privacy-Practices-Signature-half-page-English
New Patient Information
Medica Historia
NO INSURANCE VERIFICATION
Privacy Practices Information
Privacy Practices Signature

Please fill out the Patient Update form should your information change.

English Spanish
Patient Update Patient Update