Lyons
3250 N. Lincoln Ave. Chicago Il 60657
Call us:

773-935-2020

Online Patient Forms

At Lyons Family Eye Care we know how important your time is so please fill out your patient history form online to assist us in making your visit as efficient as possible.

Please complete the appropriate form below, and contact us if you have additional questions.

 

New Patient Form:Please complete this form prior to your first visit if you are a new patient to our practice.

Existing Patient Form:  Please complete this form prior to your next visit if you are a returning patient.

InfantSEE® Form:  Please complete this form to participate in InfantSEE®, our infant eye-health assessment program.

Lyons Family Eye Care cares about your privacy and personal information. The forms on our website meet federal Health Insurance Portability and Accountability Act (HIPAA) requirements and reasonable measures have been taken to secure your information. Please contact us if you feel uncomfortable providing this information online.