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®

Contact Us

We look forward to hearing from you.

Locations

Find us on the map

Hours of Operation

Our Regular Schedule

Freeport: 815-235-6177

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: 815-947-2424

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: 815-493-2700

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: 815-732-3121

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: 815-626-7700

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