PATIENT FORM | CHIC OPTIQUE

PATIENT FORMS

PATIENT INTAKE FORM

To prepare for your first CHIC Optique appointment, print out and complete the patient history form. Bring it with you, along with your photo ID, insurance card, and any prescription eyeglasses or sunglasses.

PATIENT INTAKE FORM

CARE CREDIT APPLICATION

CHIC offers CareCredit financing options to make paying for your healthcare needs easy and convenient. CareCredit allows you to obtain eye exams, contact lenses, and glasses when you need them. You can also upgrade your glasses or contact lenses and pay for them with low monthly payments. There are no upfront costs or pre-payment penalties.

CARE CREDIT FORM

PATIENT FORMS

PATIENT INTAKE FORM

CARE CREDIT APPLICATION

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PATIENT FORMS

PATIENT INTAKE FORM

CARE CREDIT APPLICATION

STAY CONNECTED