Please fill out the new patient form located in the Patient Portal and then hit the submit button to send the information directly to our office. This information provides us with your health history and other information related to providing you with the best eye health and vision solutions.
New Patient Form
New Patient Form (Spanish)
Optomap Fact Sheet (Under 40)
Optomap Fact Sheet (Under 40+)
Optomap Fact Sheet (Spanish Under 40)
New Patient Form - Medical History
New Patient Form - Medical History (Spanish)
At Bensenville Eye Care, we have been transforming lives through vision in the Chicagoland area since 1986. Schedule your appointment today!
One fine body…