Antioch Eye Associates
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Patient Forms

Integrated Forms


Printable 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.*

Health History
File Size: 89 kb
File Type: docx
Download File

HIPAA
File Size: 19 kb
File Type: docx
Download File

Records Release
File Size: 15 kb
File Type: docx
Download File

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                          Contact Us
                            31 North Ave
                        Antioch, IL 60002
                     Phone: 847-395-4090
                         Fax: ​847-395-7378
              Email: 
[email protected]
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​School aged patients enjoy a free scoop at
Hansen’s Ice Cream Parlor after your eye exam!
There is something for everyone!
 click their logo to see all of the flavors!
​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  

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

Friday June 13th the office will be closed at 12:00
Saturday June 14th The office will be CLOSED
We apologize for any inconvenience this may cause you.
​Notice of Privacy Practices
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