PEREZ EYE CARE
  • Home
  • Our Practice
  • Locations
  • Our Services
  • Patient Forms
  • Contact Brands We Offer
  • Lens Material and Designs We Offer
  • Loop Frames Line
  • Pilsen Frame Line
  • CareCredit
  • iWellnessExamTM
  • Eye Care Articles

Patient Forms

Our Goal is to provide the highest quality of care possible to our vision care patients. we do this by listening to and understanding your vision. 

Confirm your eye doctor appointment
Please confirm your appointment at:
Loop office: 312-332-0921
Pilsen office: 773-847-1581
or by email: info@perezeyecare.com

We value your time and that of your fellow customers. We require at least 24 hour notice if you need to reschedule your appointment

What to bring
You want the best care and prescription for your eyes and your lifestyle. Please bring the following to your exam so that we can understand your vision history.

* current glasses AND sunglasses
* current contact lens information
* any previous eye exam records you may have
* completed Medical History Form (English Form is on the top of this page)
* completed Contact Lens Form 
* vision care plan or medical insurance ID information

What to expect

During your first visit with us we will spend a little extra time reviewing your information so that we can fully understand your specific eye health and support your specific needs. Our practice is fully HIPPA compliant and we have already adopted Electronic Medical Records for all of our patients. 

​You temperature will be taken at the time of your visit. 

Part of a thorough eye exam is pupil dilation, which is accomplished by placing drops in your eyes to dilate or widen, the pupils. The doctors will use a special magnifying lens to examine your retina to look for signs of damage and other eye problems. After dilation, your close-up vision may remain blurred for several hours. Please let our staff members know if you prefer not to be dilated.

The iWellnessExam reveals ocular anatomy and signs of disease in exquisite detail. This breakthrough technology allows the Drs. at Perez Eye Care to examine with unprecedented clarity, structure that is invisible using traditional methods. This unique technology can help detect potentially vision threatening, as well as systematic diseases in their early stages, when they are most treatable. 

As part of your pre-exam testing, our technician will discuss having the iWellnessExam done. If you agree to the exam, the Drs. at Perez Eye Care will review the results with you during your exam.  The cost for this exam is typically not covered by your vision or medical insurance unless being used to actively follow disease.


Medical History Form - English
File Size: 66 kb
File Type: pdf
Download File

Medical History Form - Spanish
File Size: 1363 kb
File Type: pdf
Download File

Contact Lens Form - Englsih/Spanish
File Size: 358 kb
File Type: pdf
Download File

Release of Medical Records - Loop
File Size: 182 kb
File Type: pdf
Download File

Release of Medical Records - Cermak
File Size: 39 kb
File Type: pdf
Download File

Release of Medical Information - English
File Size: 73 kb
File Type: pdf
Download File

Office Policies - Spanish
File Size: 435 kb
File Type: pdf
Download File

Office Policies - English
File Size: 366 kb
File Type: pdf
Download File

Release of Medical Information - Spanish
File Size: 459 kb
File Type: pdf
Download File

HIPPA Form
File Size: 2475 kb
File Type: pdf
Download File

Patient Responsibilty Statement - English
File Size: 189 kb
File Type: pdf
Download File

Illinois Eye Exam
File Size: 65 kb
File Type: pdf
Download File

Contact Us
Loop Location
25 E. Washington Street, Suite 820
Chicago, IL 60602
Phone: 312-332-0921
Fax​: 312-332-0963
Loop - office hours
Monday: 10::30 - 6:30
Tuesday: 9:00 - 1:00  - No Dr.
Wednesday: 9:30 - 4:30
Thursday 9:00 - 4:30pm
Friday: 9:00 - 5:00
Saturday: CLOSED
Sunday: CLOSED
Contact Us
Pilsen Location
2252 West Cermak Road
Chicago, IL 60608
Phone: 773-847-1581
​Fax: 773-376-9510
Pilsen - office hours
Monday: 11:00 - 3:00 
Tuesday: 11:00 - 7:00
Wednesday: 11:00 - 7:00
Thursday 11:00 - 7:00
Friday: 10:00 - 6:00
Saturday: 9:00 - 3:00
Sunday: CLOSED

​email: info@perezeyecare.com

                                 
     Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Locations
  • Our Services
  • Patient Forms
  • Contact Brands We Offer
  • Lens Material and Designs We Offer
  • Loop Frames Line
  • Pilsen Frame Line
  • CareCredit
  • iWellnessExamTM
  • Eye Care Articles