Online Forms

At The Center for Corrective Eye Surgery, we value your time. 

In an effort to save you time in our office, you can print and complete our patient forms prior to your visit.

  • You will need AdobeReader® to download and complete the forms. Download the Free AdobeReader®
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Bring your completed form(s) to our office with you to your appointment.


Registration Form (docx)

Download & Print Form

Patient History Form (docx)

Download & Print Form

Financial Responsibility Statement (docx)

Download & Print Form

Registration Form en Español (docx)

Download & Print Form

Patient History Form en Español (docx)

Download & Print Form

Financial Responsibility Statement en Español (docx)

Download & Print Form


If you have any questions, please do not hesitate to contact our office by calling (815) 363-2020.