We are switching to a paperless form system to make your visit faster and easier. All patients will need to update their forms. Click here to learn more
We now offer Valeda Light Therapy for Dry Macular Degeneration. Click here to learn more.
Geneva Eye Clinic
Phone Phone (630) 232-1282 User Patient Portal Card Bill Pay Calendar Request an Appointment

Medical Release Request

To request your medical records (Protected Health Information) be sent to another doctor, medical practice, or to receive a copy for yourself, you may either download a paper form or make the request online.

Paper Form

Please click the button below to download a paper form. You may fax the completed to 630-313-1218 or bring it to the office.

Download Form