Order Contact Lenses


We offer a full range of soft and RGP contact lenses for our patients. If you would like to re-order contacts, please fill out the form below.  Your information is transmitted through a secure connection to protect your personal information.  Contacts will be shipped directly to you from the manufacturer.

 

Name:
Street Address:
City:
State:
Zip Code:
Telephone:
Email Address:
   
RIGHT EYE:
Contact Brand
How Many Boxes?

LEFT EYE:
Contact Brand
How Many Boxes?

   
Credit Card Type:
Credit Card Number:
Verification Code: (3-digit code located on back of card or 4-digit code on front)
Expiration Date: Month: / Year:
   
Special Instructions: