Patient Forms

Fill Out Our Forms Prior to Your Eye Care Exam

Regular eye check-ups are very important for diagnosing and treating eye diseases before they become a bigger problem. Get your eyes checked today by the experienced eye care specialists at Northern Illinois Optical Co.

If you're visiting us for the first time, we ask that you print, read through, and sign the various forms we have for you below. This will help us speed up the appointment process and provide you with the highest quality eye care services.

Printable Forms

• Click here to download the Legal and Privacy Policy
• Click here to download the Pre-Exam Form
• Click here to download the Retinal Photography Form
• Click here to download the HIPPA Release Form
• Click here to download the Insurance Claim Form
• Click here to download the Contact Lens Fitting and Evaluation Agreement Form

Visit our local, family-owned eye care clinic today at 121 N Madison St., Rockford, IL for quick and convenient eye examinations.