Patient Forms

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Save time when you come in to our office by filling out our patient registration forms before you come in for your appointment. For your convenience you may download and fill out the three required forms below. Then simply email or fax the completed forms back to us. Or you can bring the filled in forms with you to the exam. Either way you will be saving time.

Patient Information – English
Patient Information Spanish
Patient Medical History – English
Patient Medical History – Spanish
Practice Privacy


Fax number:

Oak Lawn Office: (708) 636-2022
Kedzie Office: (773) 866-2022
Orland Park Office: (708) 403-5751

State of the Art Vision Center

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Dry Eye Center of Excellence

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Cataract and Diabetic Eye Institute

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Oak Lawn

6201 W. 95TH Street
Oak Lawn, IL. 60453

Orland Park

14494 John Humphrey Drive
Orland Park, IL. 60462


4459 North Kedzie Ave.
Chicago, IL. 60625

Frame Gallery

6201 W. 95th Street
Oak Lawn, IL. 60453