Reminder that we've moved to 666 Dundee Rd, Suite 1802 Northbrook, IL 60062.​​​​​​​
​​​​​​​Pass 2 speed bumps and 2 bridges, then look for the 1700–1900 sign. Park by the handicap space and follow the sidewalk into the buildings.

Patient Forms

Patient Forms

Patient Forms

Patient Forms

Patient Forms

At Vision Rehabilitation Associates, we offer patient forms online so you can complete them at the convenience of your own home or office. You may email us the completed forms or bring them with you on your next visit.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download it.

  • Download the necessary form(s), print it out, and fill in the required information.
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  • Patient Registration Form

  • DOWNLOAD​​​​​​​

For the VRA form, there is an adult form and a pediatric form, please fill out which form applies for you. Also, there are some additional sections in each form - TBI history, Brain injury symptoms survey, dry eye, dizziness and motion sensitivity survey, extensive pediatric history, that may not be applicable for general exams. Please fill out the sections that are relevant for you.

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