Antioch Eye Associates
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Patient Forms

Integrated Forms


Patient Forms 
Please fill out the health history form below or arrive at the office 10 minutes BEFORE your scheduled appointment time to fill them out in office.
                                                                                                                 *Record Release Form not required for appointment.*

Np_forms_2021.pdf
File Size: 293 kb
File Type: pdf
Download File

Record Release
File Size: 18 kb
File Type: docx
Download File

Contact Us
31 North Ave
Antioch, IL 60002
Phone: 847-395-4090
Fax: ​847-395-7378
Email: eyedocs@antiocheyeassociates.com
            Can email to request appointment



Office Hours
Mon    7:00 am - 5:00 pm
​Tues    9:00am - 4:00pm 
Wed   7:00 am - 6:00 pm
Thu     7:00 am - 5:00 pm             
            Closed 12 pm-1 pm        
Fri       7:00 am - 3:00pm  
Fri Jan 27th CLOSE at 12pm

Sat      8:00am - 12:00pm  ( 1st three Saturdays of the month) 

31 North Ave Antioch, IL 60002

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  • Our Practice
  • Our Services
  • Patient Forms
  • Promotions
  • Eye Care Articles
  • Location
  • Vitamins