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Salisbury MD - Berlin MD - Pocomoke, MD | (410) 749-9290

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MEDICAL HISTORY

Date

Name

Social Security #

Age

Gender

REASON FOR VISIT

EYE/ENT SYSTEM REVIEW (PLEASE CHECK ALL THAT APPLY)

EYE PAIN

LIGHT FLASHES

STRAIGHT LINES APPEAR CROOKED

BLURRED VISION

ITCHY/WATERY EYES

DIFFICULTY WITH NIGH VISION

GLARE/LIGHT SENSITIVE

DRY EYES

SINUS/NASAL CONGESTION

DRY THROAT

OTHER

About Us

Peninsula Eye Center's Board Certified Ophthalmologists and Board Certified Optometrists make sure your needs and expectations are placed at the highest level.

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Types of Services

Eye Examinations

Glasses

Contact Lens Services

Diagnostic Eye Care

Medical Eye Care

Surgical Eye Care

Main Office

Peninsula Eye Center

101 Milford Street

Salisbury, MD 21801

(410) 749-9290

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