Evelyn Marie Moore, O.D. - Patient History Form
Evelyn Marie Moore, O.D.

This form is required for new patients. At your convenience, you may print this off and fill the information out before your appointment. The information is critical to the evaluation of your vision and health.


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Round Barn Center
501-B South Mattis Avenue
Champaign, IL 61821
Map It!
Directly east of Famous Dave's Restaurant. We're in the same building as Wireless Mike's Verizon store.

Phone: (217) 351-4106
Fax: (217) 351-4052
Cell Phone: (217) 369-2544
Email Us

Mon, Thu 8:00am - 5:00pm
Tue 8:00am - 6:00pm
Wed, Fri 7:30am - Noon
Sat 8:00pm - 2:00pm
Vision Examinations by Appointment Only. Our office is open until 5:00 pm on Friday's. Early morning, late afternoon, and Saturday appointments are available on a limited basis.