CHIKA EYE CARE
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Patient Forms

Patient Forms

Secure Online Forms

Welcome Form
File Size: 6 kb
File Type: pdf
Download File

Medical History Form
File Size: 52 kb
File Type: pdf
Download File

We are hiring! Click the link to apply : employment_application.docx
  PLEASE PRINT OUT YOUR COMPLETED FORMS AND BRING TO THE VISION CENTER!
   We look forward to serving you!

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Contact Us:
122 Smallwood Village Center
Waldorf, MD 20602

Phone: 240-419-3846
​240-419-3852

Fax:240-222-3476

Email Us


Office Hours:
Mon, Tue,  Wed:
​10:00 am - 5:00 pm
Thurs-Fri: 10:00 am- 7:00 pm
Sat : 10:00 am - 3:00 pm
No Walk in Eye Appointments!
Please Call to Schedule your appointment 

Notice of Privacy Practices
Website by Eyefinity

  • HOME
  • Our Practice
    • Our Services >
      • Eye Care Articles
  • Patient Forms
  • Location
  • Appointments
  • Privacy Notice