CHIKA EYE CARE
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Patient Forms

pATIENT FORMS 

We encourage all patients to print the patient forms below and fill them out before the scheduled appointment. We look forward to seeing you at your next appointment. 
 
Welcome Form
File Size: 275 kb
File Type: pdf
Download File

Medical History Form
File Size: 279 kb
File Type: pdf
Download File

We are hiring! Click the link to apply : employment_application.docx

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