-. Eye Exam Appointment Plainfield illinois | Windy City Retina
(815)714-9115
contact@windycityretina.com
Appointment

Appointment

APPOINTMENT Form

**IF THIS IS AN EMERGENCY, PLEASE CALL THE OFFICE TO SCHEDULE YOUR APPOINTMENT

Reason for Visit (Required)

Age Related Macular Degeneration (Wet)Age Related Macular Degeneration (Dry)Retinal Tear/DetachmentFlashes and/or FloatersDiabetic Retinal ChangesVascular OcclusionDecreased/Distorted VisionRetinal HemorrhageRetinal EdemaOther

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Vision (Please enter if you are a Referring Provider)

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Referring Doctor

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CONTACT INFORMATION

 (815)714-9115
 contact@windycityretina.com
Disclaimer -Do not send sensitive patient information, only general questions.
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HOURS

Monday – Thursday: 9am – 4pm
Friday: 9am – 1pm Saturday & Sunday: CLOSED EMERGENCIES: Call office for on-call doctor