New Patient Request

Welcome! We're happy that you'd like to become a patient in our clinic. Please submit the form below so we can more effectively serve you.

What would you like the doctor to know about your specific eye health and vision care needs?

Is your visit routine? If not, please explain the nature of your eye or vision problem

Authorization to Realease of Medical Form
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Roya1234 none 8:30 AM - 5:00 PM 8:30 AM - 5:00 PM 8:30 AM - 12:00 PM 8:30 AM - 5:00 PM 8:30 AM - 5:00 PM Closed Closed optometrist https://www.google.com/maps/place/Rieger+Eyecare+Group/@40.5193159,-88.9641074,17z/data=!4m7!3m6!1s0x880b70ed9736d5d7:0xa0d1638b081ba450!8m2!3d40.5193159!4d-88.9641074!9m1!1b1