Patient Forms
Chicago, Illinois
Patient Registration Documents:
- Patient History Form (click to fill out)
- Permission for Release of Patient Medical Records (pdf)
- Do you want to have your records sent to our office? (pdf)
Refractive Surgery Documents:
- LASIK Packet (pdf)
- PRK Packet (pdf)
- CK Packet (pdf)
- FDA Laser Information (pdf)
- HIPAA Packet (click to fill out)
- HIPAA Contact Form (click to fill out)