d LASIK | Cataract | Chicago, IL | Gerstein Eye Institute | Eye Care | ICL

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To provide our patients with the best care possible, we request that they fill out two forms so we can better understand the condition of their health.

These forms are located on this page in PDF format. To download them for your use, just click on the link. Please fill out the forms completely, then bring them to us during your first appointment.


Patient Information Form
Download PDF
Download PDF
(20 KB)
Patient History Form
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Download PDF
(24 KB)

You will need the Adobe Acrobat Reader to view
and print PDF files. Download it now for free.




3042 W. Peterson Avenue (Just east of Lincoln), Chicago, IL - 773-973-3223 - 24 Hour Answering Service