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 |
| Medical History Form - Spanish |
| Contact Lens Form - Englsih/Spanish |
| Release of Medical Records - Loop |
| Release of Medical Records - Cermak |
| Release of Medical Information - English |
| Office Policies - Spanish |
| Office Policies - English |
| Release of Medical Information - Spanish |
| HIPPA Form |
| Patient Responsibilty Statement - English |
| Illinois Eye Exam |