New Patients

Welcome to the New Patient Center for Looking Out Vision

We welcome you to our office. It is our goal to provide you with the best eye care. To provide the most comprehensive eye care, we need a snapshot of your current overall health status. The forms we ask you to fill out will give this to us. You can download the forms from this page, we can mail them to you, or you can arrive 10 minutes early and fill them out in our office.

Please Bring the Following:

Completed forms
Insurance Cards
List of all medications, eye drops, vitamins and supplements (include dosage and how many you take each day).
All current eyewear: glasses, sunglasses, contacts (bring the boxes if you have them).

If you need to reschedule
please give our office 24 hour notice.

Call 815-942-1951 or Text 815-900-5181.

Patient Forms

It is always our goal at Looking Out Vision to give you the eye care you deserve in a timely manner.

In order to ensure that your first visit goes smoothly, you may want to complete the forms below prior to your visit. You can even fax us your forms or drop them off prior to your appointment to speed up your first visit.

Patient Forms

Eye History

Medical History

Medical History 2

Kid's Preparation

Records Release

Insurance and Payments

At Looking Out Vision our goal is promote good eye health and enable you to have the clearest vision possible.

We accept most medical insurance, cash, checks, care credit and most credit cards. For our self-pay patients, we give a 25% same day pay discount on annual eye exams if paid for on the same day as the visit.