Patient Forms


To better assist our patients, we have provided all our registration forms. At your convenience, please print off all three forms, fill them out and bring them to your appointment. If you have any questions regarding these forms, please leave it blank and we can assist you when you arrive for your appointment.

As of January 1, 2008, Illinois passed a new law requiring all students entering Kindergarten to provide proof of an eye examination. This exam can only be completed by an optometrist or an ophthalmologist and must be completed prior to the child starting Kindergarten (or at which ever age the child enrolls in school). Please print out the form to the left and bring to your child's eye exam. The form will be returned to you for you to submit to the school.

New Patient Registration Form
Illinois School Exam Form
Advanced Eyecare Clinic
45 West Acorn Lane
Lake in the Hills, Illinois 60156
(847) 854-0202
[email protected]
Fax: (847) 854-0299
Monday9:00am - 5:30pm
Tuesday8:00am - 6:00pm
Wednesday8:00am - 6:00pm
Thursday10:00am - 7:00pm
Friday9:00am - 4:00pm

Patient care hours may vary from office hours.

Contact Us Today To Schedule Your Next Eye Exam.

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