Patient Forms
Chicago, Illinois
Patient Registration Documents:
- Patient Registration Form (pdf)
- Patient History Form
- Permission for Release of Patient Medical Records (pdf)
- Do you want to have your records sent to our office? (pdf)
- Patient History Form for Doctors for Visual Freedom
LASIK Documents:
- LASIK Consent (pdf)
- Day LASIK Procedure (pdf)
- LASIK Postoperative Instructions (pdf)
- FDA Laser Information (pdf)
- LASIK Packet (pdf)
PRK Documents:
- PRK Consent (pdf)
- PRK Preoperative Instructions (pdf)
- PRK Postoperative Instructions (pdf)
- PRK Packet (pdf)
Cosmetic Treatments:
Additional Information:
- Questions about Cataract Surgery (pdf)
- Questions about Glaucoma (pdf)
- Dry Eye (pdf)
- Questions about Macular Degeneration (pdf)
- Questions about Diabetic Retinopathy (pdf)
- Medicare Release (pdf)
- CK Packet (pdf)
- Required HIPAA form for Doctors For Visual Freedom
- Required HIPAA form for Golden Eye Surgeons and Consultants
- Golden Eye Surgeons and Consultants (pdf)
Two Locations:
Doctors for Visual Freedom Laser Center
875 North Michigan Avenue, Suite 1550
Chicago, IL 60611 | Doctors for Visual Freedom Laser Center
2010 S Arlington Heights Rd, Suite 121
Arlington Heights, IL 60005 |
