Eye Institute Patient Forms

Expedite Your Visit

We are looking forward to your first visit at the Midwestern University Clinics. It is our sincerest goal to make your visit as pleasant as possible. If you are a new patient, we will need you to fill out a few forms before your initial appointment. For your convenience, you can download the necessary forms and complete them prior to your visit. Please bring these forms with you to your first appointment. We realize that your time is important and this will greatly expedite the registration process.

Patient Forms

• Patient Authorization & Assignment of Benefits
• Student Acknowledgement
• Child Questionnaire
• Patient Questionnaire
• Financial Policy & Disclosure
• Teacher Observation Checklist
• Third Party Consent Form