Online Forms

At AssureVision, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form


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LOCATIONS

ARLINGTON TOWN SQUARE  
58 S. Arlington Heights Rd  
Arlington Heights, IL 60005  
Phone: 847-368-9999

BARRINGTON VILLAGE CENTER  
143 W. Main Street  
Barrington, IL 60010   
Phone: 224-407-2020

GLEN TOWN CENTER  
1871 Tower Drive 
Glenview, IL 60026  
Phone: 847-724-2020

Contact Us

We look forward to hearing from you.

Hours of Operation

Our Regular Schedule

Arlington Heights - Arlington Town Square

Monday:

10:00 am-6:00 pm

Tuesday:

By Appointment Only

Wednesday:

10:00 am-6:00 pm

Thursday:

By Appointment Only

Friday:

10:00 am-6:00 pm

Saturday:

10:00 am-3:00 pm

Sunday:

Closed

Barrington - Barrington Village Center

Monday:

By Appointment Only

Tuesday:

9:00 am-5:00 pm

Wednesday:

By Appointment Only

Thursday:

9:00 am-5:00 pm

Friday:

By Appointment Only

Saturday:

By Appointment Only

Sunday:

Closed

Glenview - The Glen Town Center

Monday:

By Appointment Only

Tuesday:

By Appointment Only

Wednesday:

By Appointment Only

Thursday:

By Appointment Only

Friday:

By Appointment Only

Saturday:

By Appointment Only

Sunday:

Closed

Locations

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Testimonials

Reviews From Our Satisfied Patients

  • "Dr Lomazov is very thorough and personable. I trust her to do a great screening."
    Sherry Kurz
  • ""All employees were happy to assist in my questions enabling me to know the perfect glasses to enhance the frame of my face.""
    Kathy Hohs
  • "I am a first time customer of Assure Vision in Barrington. I highly recommend this practice for their professionalism, great attention to detail, customer support and friendly, family atmosphere. They work very hard to please and make sure the customer is happy with every aspect of their eye care. With confidence, I am truly a repeat customer for a lifetime. Thank you for all you do!"
    Anne B.

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