Patient Forms

For your convenience new patient paperwork is available on your patient portal. Please call our office at 847-253-4040 to provide a valid email address so we may configure. If you have already received your welcome email please go to your Patient Portal 

 

Financial Policy

Dilation Facts and Information
 Self-Pay Pol//C1-preview.prosites.com/65849/wy/docs/Self-Pay Patient Financial Responsibility Form final.docxicy
 

Authorization to Release Medical Records Forms

Authorization Release TO Suburban Associates in Ophthalmology

Authorization Release FROM Suburban Associates in Ophthalmology

 Notice of Privacy Practices
 HIPAA Patient Acknowledgment and Consent - SAO

HIPAA Notice of Privacy 

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.