ILLINOIS OCULOPLASTIC ASSOCIATES, S.C.
(708) 444-7200
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    Patient Registration Form:

    Consent to treatment and release of information:

    Unless otherwise directed below, if I am unavailable, the Physician may communicate normal test results via telephone, voicemail, or answering machine to the phone numbers on this form, as long as the nature of the call is not disclosed. 
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M-F: 8am - 4pm

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708-444-7200
708-444-7233
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