Accessibility Call (847) 253-4040

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.

Dilation Facts and Information

Financial Policy

Self-Pay Waiver/Patient Financial Responsibility Form

Medical Record Release Forms

Authorization Release FROM SAO

Authorization Release TO SAO

Notice of Privacy Practices

HIPAA Patient Acknowledgment and Consent - SAO

HIPAA Notice of Privacy

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