Online Forms

At Northwest Eyecare, 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.
  • 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.

Medical History Questionnaire

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 PDF Form

Download & Print Word Document


Download the Free AdobeReader®

Locations

Find us on the map


Hours of Operation

Our Regular Schedule

Freeport:

Monday:

8:00 am-6:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

8:00 am-5:00 pm

Saturday:

Closed

Sunday:

Closed

Stockton:

Monday:

Closed

Tuesday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Wednesday:

Closed

Thursday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Friday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Saturday:

Closed

Sunday:

Closed

Lanark:

Monday:

8:00 am-1:00 pm

2:00 pm-6:00 pm

Tuesday:

Closed

Wednesday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Thursday:

Closed

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Oregon:

Monday:

Closed

Tuesday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Wednesday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Thursday:

Closed

Friday:

8:00 am-1:00 pm

2:00 pm-5:00 pm

Saturday:

Closed

Sunday:

Closed

Rock Falls:

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Reviews From Our Satisfied Patients

  • "Injured my eye and Northwest Eye Care saw me right away. Very professional and service was outstanding. Thank you!!"
    Brian S.
  • "I can’t thank Donna and the rest of the team enough for getting me in with urgency today as soon as I called with an issue. Such great people to their customers. I would recommend 10/10 times!"
    Bryn B.
  • "Absolutely fantastic experience, this is the third time I've been here, and I was so impressed with Dr. Diemer's customer service, I had to write this review. I wish there was a category for 6 stars."
    John M.