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  • Our Doctors
    • Eric J. Quartetti, M.D.
    • Brian L. Heffelfinger, M.D.
    • Saima Jalal, M.D.
    • Lucas J. Wendel, M.D.
    • Christy M. Harvey, M.D.
    • Abid A. Haseeb, M.D.
    • Maria Pica, O.D.
    • Alexandria Halkias, O.D.
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Patient Forms

Home / Patient Resources / Forms

New Patient Forms

Save time at your first visit by downloading and completing these forms before you arrive. Please bring the completed forms with you to your appointment.

  • Medical History Form (English)
  • Medical History Form (Spanish)
  • Patient Demographics Form

Medical Records Release

Use this form to authorize Fox Valley Ophthalmology to release your medical records to another provider or to yourself.

  • Download Medical Records Release Form
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