Online Forms

Online Forms

Online Forms

Online Forms

Online Forms

Online Forms

Online Forms

At Wear Eyewear, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.​​​​​​​

  • You will need AdobeReader® to download and complete the forms. Click here to download.

  • Download the required form(s). Print out the form(s) and complete the required information.

  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form

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Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form.

Download & Print Form


HIPAA Notice of Privacy Practice

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Download & Print Form


HIPAA Signature Page

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Download & Print Form

MawzPawz254@ none 230 W. Superior St. Suite 100N,
Chicago, IL 60654 14215 LaGrange Road
Orland Park, IL 60462 3126260036 7083499327 3122551367 7083499473 chicago@weareyewear.com orland@weareyewear.com 9:00am - 5:00pm 10:00am - 5:00pm 9:00am - 6:00pm 10:00am - 5:00pm 9:00am - 5:00pm Closed Closed 10:00am - 5:00pm 10:00am - 5:00pm 10:00am - 5:00pm 10:00am - 5:00pm 10:00am - 5:00pm 9:00am - 3:00pm Closed https://www.facebook.com/WearEyeWearChicago/ https://www.facebook.com/WearEyeWearOrlandPark