google-site-verification=DiTUFuAiWINQ18W-LAG0pVDnTvYof9qZfpi4G0wh2Oc PATIENT FORM | CHIC OPTIQUE | United States
HOURS

Monday-Friday 10am to 6pm

Saturday 10am to 4pm

Closed on Sunday

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2228 Wilton Drive

Wilton Manors, Fl 33305

954-567-3937

© 2019 by 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.

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.