New Patient Forms

 Hello and Welcome to the Northern Illinois Eye Clinic!

We are pleased and honored to have you as a patient.  The following forms can be filled out and printed or emailed to us prior to your visit if you desire.  Please click below for a general history questionnaire, our financial policy form, glasses and contacts policy, and HIPAA  forms.

Our email: info@northernillinoiseyeclinic.com

Fax: 847-566-5310

 

New Patient History Questionnaire (2 pages)

Patient Financial Terms Agreement (2 pages)

HIPAA forms

List of Insurances Accepted