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Order Contacts

If you are a previous patient of ours, and if you have a prescription that is less than one year old, you can now reorder your contact lenses online. Please fill out and submit the form below, and your lenses will be mailed to you within one week. We will call you to confirm your order.




Lens Specs:
OD Lens (right)		OS Lens (left)
Manufacturer:		Manufacturer:
Name / Type:	Toric	Name / Type:	Toric


Color:	(some Ciba lenses)	Color:	(some Ciba lenses)

Wear Type:		Wear Type:

Power:		Power:

Base Curve:	Diameter:	Base Curve:	Diameter:

Quantity:	packs	Quantity:	packs




Doctor:
Clinic Location:




Payment Info:

Credit card information will be taken by phone when we call you to confirm your order.

General Information:
	Name:
	Address:
	Appt / Suite:
	City:
	State:	Zip:
	Email:
	Daytime Phone:

(We will call you to confirm your order.)

Contact lense prescriptions are filled only with a valid optometrist's prescription. We will verify and confirm your order on the next business day.

For your convenience, we accept most major credit cards including Visa, Mastercard, American Express, and Novus.