(847) 243-3330

  • Eye See

    275 Parkway Dr Ste 415,
    Lincolnshire, IL 60069

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HIPAA Privacy Consent and Compliance

Access our patient forms that you can fill out before your next visit to EyeSee in Lincolnshire,IL.

As a condition of providing treatment and care to you, our office must obtain your consent to use and disclose protected health information about you to carry out the necessary treatment, care, payment, and healthcare operations of our office. 

You have the right to revoke consent at any time by notifying our office staff in writing, except to the extent that our office has already taken actions relying on your authorization. You have the right to request our office to restrict the manner in which your protected health information is used and/or disclosed. Our office is not required to agree to such requested restrictions; however, we will do our best to comply with any such request

I hereby consent to the use and disclosure of my protected health information by EyeSee LLC, its workforce, and its business associates for treatment purposes, payment, and health care operations. I am aware I can request a copy of EyeSee LLC.  

A Compliant “Notice of Privacy Practices” and it will be provided.

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Please do not submit any Protected Health Information (PHI).

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We hope to see you soon

  • Eye See

    275 Parkway Dr Ste 415,
    Lincolnshire 60069

    Monday:

    10:00 am - 6:00 pm

    Tuesday:

    9:00 am - 5:00 pm

    Wednesday:

    11:00 am - 7:00 pm

    Thursday:

    10:00 am - 6:00 pm

    Friday:

    12:00 pm - 6:00 pm

    Saturday:

    9:00 am - 4:00 pm

    Sunday:

    Closed

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Please do not submit any Protected Health Information (PHI).

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Eye See

Address

275 Parkway Dr Ste 415
Lincolnshire, IL 60069

Contact Information (847) 243-3330

(847) 243-3332

[email protected]

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