Doctors For Visual Freedom
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patient  forms

Patient Forms

Dvf_patient_registration_forms.pdf
File Size: 419 kb
File Type: pdf
Download File

Please fill out this form and bring it with you to your examination.
 Thank you
HIPAA
File Size: 37 kb
File Type: pdf
Download File

The Federal Government requires all patients to see this form.  We will ask for you to sign this form at the time of your visit or you may print it and bring it with you.
Notice of Privacy
File Size: 96 kb
File Type: pdf
Download File

Botox Consent Form
File Size: 85 kb
File Type: pdf
Download File

Please read through this form if you want to have Botox at the time of your visit.
Juvederm Consent Form
File Size: 170 kb
File Type: pdf
Download File

Please read through this consent form if you are interesting in obtaining Juvederm at the time of your visit.
Contact Us
Doctors For Visual Freedom
875 North Michigan Avenue #1550
The John Hancock Center
Chicago, Illinois 60611
Phone: 312-291-9680

Office Hours
Mon    9:00 am - 5:00 pm
Tue     9:00 am - 5:00 pm
Wed    9:00 am - 5:00 pm
Thu     9:00 am - 5:00 pm
Fri       9:00 am - 2:00 pm
Sat      9:00 am - Noon (by appointment only)

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Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Our Services
    • Special Events
    • Promotions
  • Patient Forms
  • Eye Care Articles
  • LASIK Surgery
  • Our Brands
  • Location