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Elgin: 847.695.0499
  • Our Doctors
    • Eric J. Quartetti, M.D.
    • Brian L. Heffelfinger, M.D.
    • Saima Jalal, M.D.
    • Lucas J. Wendel, M.D.
    • Christy M. Harvey, M.D.
    • Abid Haseeb, M.D.
    • Maria Pica, O.D.
    • Alexandria Halkias, O.D.
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Patient Forms

Home / Patient Resources / Forms

New Patient Forms

Save time at your first visit by downloading and completing these forms before you arrive. Please bring the completed forms with you to your appointment.

  • Medical History Form (English)
  • Medical History Form (Spanish)
  • Patient Demographics Form

Medical Records Release

Use this form to authorize Fox Valley Ophthalmology to release your medical records to another provider or to yourself.

  • Download Medical Records Release Form
Fox Valley Ophthalmology

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The material contained on this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you require TTY services or screen-reader assistance, please call us directly at (630) 584-9850.

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