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New Patient Center

Forms

Insurance & payments

Welcome to the New Patient Center for GEORGE A ROEBUCK OD

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:

1.Completed forms

2.Insurance Cards

3.List of all medications, eye drops, vitamins and supplements (include dosage and how many you take each day).

4.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