3477 Grand Avenue, Gurnee, IL 60031

Patient Forms

To view and print our patient forms, please click on the links below. Please fill the forms out and bring them with you to your appointment with SureVision Eye Centers.

Patient Information Form Lifetime Assignment of Benefits

Meaningful Use Demographics FormNotice of Privacy Practices

Medical Records Release Form

Patient Portal

Patient Portal login information

Login- 1st initial, last name, 4 digit date of birth

ie:  jdoe1950

Temporary Password- 2Eyeballs



Payment Options