Patients who have undergone Contact Lens Fittings with regular periodic follow-up care in our office, as prescribed by our doctors, may reorder their Contact Lenses for home delivery through this web site. This service allows for both convenience and accuracy of your Contact Lenses under the supervision of your doctor.

Please reorder Contact Lenses using the form below:

 

* = Required Information
Patient Information:
Patient Name: *
Your Name:
Relationship to Patient:
Email Address:
Home Phone:*
Work Phone:
Address:*
City: *
  State:*   Zip:*
Preferred Method of Contact:   Email          Phone
   
   
Contact Lens Information:
Box Quantity for Right Eye:*

Box Quantity for Left Eye:*

Brand (if known):

   
Please check one:* I will pick up my order.
Please mail my order to me.        (Mailing address is required.)
Any Additional Information:

 

 
       
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