PATIENT FORMS New Patient Forms Prior to your first visit, please ensure you complete the following New Patient Packet and bring a copy to your first appointment. If you have any questions or need assistance with these forms, please don't hesita te to call our office . We are here to help and ensure a smooth and efficient process for your visit. We look forward to seeing you soon! English New Patient Packet.pdf Spanish New Patient Packet.pdf New Patient Forms Fillable PDF Office Documents and Notices Amsler's Grid Click the link below to access the document. Non-Covered Services 2023 Click the link below to access the document. Fluorescein Angiogram Information Click the link below to access the document. Review our practice! Injection Aftercare Click the link below to access the document. Artificial Tear Regimen Click the link below to access the document.

COVID-19 UPDATES FOR YOUR VISIT Retina Health Institute is committed to the health and safety of our patients during this uncertain time. We are actively contacting patients that do not need to be seen over the next few months to reschedule their appointments. If you do not receive a call to reschedule your appointment , the physicians have deemed your visit and treatment essential and you should keep any scheduled appointments to avoid vision loss. Below is a list of center updates to help patients prepare for their appointments. ​ All patients and staff must be screened for COVID19 symptoms and exposure prior to entering the office . If you are experiencing any symptoms of a respiratory tract illness or pink eye, please reschedule your appointment. Patients must wear a face covering for the entirety of their visit as outlined by the state of Illinois and the CDC Latest CDC guidelines can be found here All staff members are required to wear a mask and gloves while they are in the office VISITORS ARE NOT PERMITTED WITHIN THE OFFICE UNTIL FURTHER NOTICE Patients should wait in their vehicle until they receive a phone call or text message from the office asking them to come to the front desk to check in for their appointment​ New patients should complete new patient paperwork prior to arriving at the office for their appointment. All patient areas are sanitized after each patient encounter with products approved by the EPA to kill COVID19 and t he office is fumigated once a week with a product approved by the EPA to kill COVID19 as an extra precaution for our patients and staff. Telehealth appointments are available upon request

Surgery FAQs and Forms What is a vitrectomy surgery? Answer: A vitrectomy is a surgical procedure that involves removing the vitreous gel from the inside of the eye. This procedure is performed to treat various retinal conditions, such as retinal detachment, macular holes, or diabetic retinopathy. Why is a vitrectomy recommended? Answer: A vitrectomy is recommended to address retinal disorders or conditions where the vitreous gel is causing issues, such as retinal tears, bleeding, or the need for surgical access to repair the retina. What are the steps of a vitrectomy surgery? Answer: During a vitrectomy, the surgeon makes small incisions in the eye wall to access and remove the vitreous gel. The surgeon may also perform additional procedures, such as laser treatment or the placement of a gas or oil bubble, depending on the specific condition. How long does a vitrectomy surgery typically take? Answer: The duration of a vitrectomy surgery can vary but usually ranges from 1 to 3 hours, depending on the complexity of the case. What is the expected recovery time after vitrectomy surgery? Answer: The recovery time after vitrectomy surgery can vary depending on the individual and the specific condition being treated. It may take several weeks to months for vision to stabilize and improve fully. What restrictions or precautions should I follow after vitrectomy surgery? Answer: After vitrectomy surgery, you may be advised to avoid strenuous activities, heavy lifting, and activities that could increase eye pressure. Follow your surgeon's post-operative instructions carefully for the best recovery outcome. ​ ​ ​ ​ Surgical Forms

Healow Patient Portal Access Locations Algonquin Office 2320 N Huntington Drive ALGONQUIN, IL 60102 Rockford Office 1075 Featherstone Road Suite 10 Rockford, IL 61107 Contact Us Healow Portal ​Convenient Locations: We are conveniently located at our new office off of South Randall Road in Algonquin, IL and opposite Rockford University in Rockford, IL. Contact Options: Our dedicated staff and surgeons are available and eager to address any questions you may have. You can reach us through the following met hods: ​ Phone : C all us directly at 847-488-1030 ​ Patient Portal : (link below) For both clinical and non-clini cal inquiries, as well as access to your records, you can use our secure patient portal. Access the portal thro ugh the link provided below (if applicable). (NOTE: the patient portal is for non-emergencies only. ) ​ ​ Contact Form : If you have non-clinical and non-emergency questions or concerns, please use the contact form below. ( NOTE: the c ontact form below is for non-clinical and non-emergencies only.) ​ Please note that in the case of a medical emergency, do not hesitate to call our office number immediately. If the situation requires urgent attention, please call your local emergency number or seek immediate medical attention. We value your well-being and are committed to providing the best support possible. Feel free to reach out to us through any of these channels, and we'll be happy to assist you. Healow Patient Portal Access Success! Your message has been received. If you asked a question, please expect to hear back from us within 2 business days. Send

WHAT TO EXPECT NEW PATIENT VISIT Your first appointment will most likely be a referral from another doctor. Please plan on arriving 15 minutes early to help ensure we have the information we need to continue with the visit. To speed up this process we ask that you complete the New Patient forms located in the "Patient Forms" tab PRIOR to arriving. We also ask that you bring in the following: Photo ID All insurance cards Medication list (including vitamins) Medical history Any relevant medical records you possess ​ The flow-chart below gives an idea of what a typical visit looks like for a new patient: Dilation causes blurring of near vision and increases sensitivity to light. Though it is legal to drive dilated, it is recommended that you arrange to have someone drive you home after the consultation. You may wish to bring sunglasses with you to protect from sunlight. RETURNING PATIENT VISIT During each visit, we prioritize comprehensive care by repeating any necessary exams and evaluations. This may involve dilation to enable the doctor to assess the back of your eye effectively. Please note that the specific procedures may vary depending on the nature of the visit (follow-up, testing, treatment), as well as the complexity of the disease. ​ To provide insight into the typical subsequent visit, we have prepared a flowchart below , outlining the general sequence of events you can expect during your appointment. Our goal is to ensure that you receive the best possible care tailored to your individual needs. Rest assured, our team is here to guide you through the process and address any questions or concerns you may have. Your vision health is our priority, and we are dedicated to making each visit a seamless and informative experience. Dilation causes blurring of near vision and increases sensitivity to light. Though it is legal to drive dilated, it is recommended that you arrange to have someone drive you home after the consultation. You may wish to bring sunglasses with you to protect yourself from sunlight. FOR QUESTIONS REGARDING YOUR STATEMENT: Please contact your insurance PRIOR to calling our office. We are unable to provide plan-specific infor mation about your statement or visit.

World-Class Specialists State of the Art Technology 24/7 Access to Care At Retina Health Institute , we specialize in the medical and surgical management of vitreoretinal diseases. With offices conveniently located in Algonquin, IL, and Rockford, IL, we offer comprehensive treatment for macular degeneration, diabetic retinopathy, retinal vascular disorders, ocular malignancies, and many other diseases of the macula, retina, and vitreous. ​ We persevere to provide high-quality, comprehensive medical and surgical retina care to all our patients. WE WANT TO HEAR FROM OUR PATIENTS! Patient satisfaction is very important to us! We are always looking for new and innovative ways to improve your patient experience. Please take a moment to complete the patient satisfaction survey by clicking on the button below. Patient Satisfaction Survey Patient Satisfaction Survey Retina Health Institute is the pioneer in bringing Proton Beam Radiation for Ocular Melanoma to the Midwest. Meet Our Physicians Algonquin & Rockford Retina Surgeon Rashmi Kapur, MD ​ Dr. Kapur is a board-certified, fellowship-trained vitreoretinal surgeon with expertise in the management of macular degeneration, diabetic retinopathy, retinal detachments, retinal vascular disease, ocular oncology, uveitis, and other vitreoretinal diseases. More About Dr. Kapur >> Algonquin & Rockford Retina Surgeon Rehan M. Hussain, MD ​ Dr. Hussain is board certified by the American Board of Ophthalmology. He is a member of the American Academy of Ophthalmology, American Society of Retina Specialists, and the Vit-Buckle Society. He has presented retina-related research and surgical videos at numerous national meetings. More About Dr. Hussain >> WE CARE FOR THE LIGHT IN YOUR EYES Healow Patient Portal Access WHAT PEOPLE SAY THOMAS, PATIENT “Dr.Kapur has been treating me since an emergency retinal detachment in 2014. As this was a total unexpected event, I was shocked and afraid of losing my vision. Dr.Kapur not only took the time to explain the entire procedure, her skill as a gifted surgeon, and her passion for my total recovery and after care are evident in every visit. I TOTALLY RECOMMEND HER TO ANYONE FACING EYE ISSUES AS SHE IS THE BEST!!!” BUMA, PATIENT “I am so appreciated and grateful to have Dr.Rashmi Kapur in my life. Many of your patients have recommended you as a good doctor. But I am going one step further to also to recommend you as a great human being. Thanks.” DON, PATIENT Dr. Kapur performed quick & painless retinal laser work for me in 2013. I was quite impressed with her skill, care & kind approach. Last week, I had an urgent need for additional eye surgery. Once again, she came through for me. I recommend her highly.