New Patient Paperwork
4Sight iCare offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
Comprehensive Eye Exam Intake Form (including HIPAA)
Click to Download
Dry Eye (& Allergy) Assessment
Click to Download
Tear Gland Treatment
Click to Download
Myopia Management (control) Program
Click to Download
Ocular Nutrition
Click to Download
Vision Training (Therapy) Program
Click to Download
Back to School Eye Exam Report
Click to Download
B4EP (Benefits 4 Established Patients)
Click to Download
Skip the Line at the DMV with a Vision Specialist Report
Click to Download
Eye Exam Quote 4 Every Stage of Life
Click to Download
Prescribed Eye Care Report
Click to Download
Prescribed Vision Report
Click to Download
OFFICE HOURS
Monday
Virtual Consultations Only
Tuesday
12:00pm - 8:00pm
Wednesday
10:00am - 6:00pm
Thursday
10:00am - 6:00pm
Friday
10:00am - 6:00pm
Saturday
9:00am - 2:00pm
Sunday
Closed
4Sight iCare
11914 Illinois Rte 59 Unit 106
Plainfield, IL 60585
P: (815) 676-4474
F: (815) 267-6521