Patient Forms

Access our patient forms that you can fill out before your next visit to Westbrook Vision Center in Peoria.

Our Forms

Patient Information Form [URL]
Medical Records Release Form [PDF]

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I have what is among the most difficult contact lens prescriptions (7.34/7.18 +8.5/+5.25). I'd been suffering through poor vision for over 10 years until I happened upon Dr. Smith. This guy is a rockstar! VERY friendly, down to earth, great sense of humor...you'd think he was your BBQ neighbor...but don't be fooled. When he's taking measurements and doing his thing, it's like some sort of professional, magic visor is down. Talk about hair splitting...he was relentless in ensuring I left with no less than 20/20 vision. I can't remember the last time I've seen this well!! THANK YOU DOC, YOU ROCK!
jpottstwo