Patient Forms

- Senior Citizen Discounts

- Competitive Prices

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Fill Out Our Forms Prior to Your Eye Care Exam

Regular eye check-ups are very important for diagnosing and treating eye diseases before they become a bigger problem. Get your eyes checked today by the experienced eye care specialists at Northern Illinois Optical Co.


If you're visiting us for the first time, we ask that you print, read through, and sign the various forms we have for you below. This will help us speed up the appointment process and provide you with the highest quality eye care services.

Printable Forms


Visit our local, family-owned eye care clinic today at 121 N Madison St., Rockford, IL for quick and convenient eye examinations.

Complete Our Forms Before Your Visit

Call for more information

(815) 963-3454

(815) 963-3454

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Northern Illinois Optical

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