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Holiday Specials click here 

18-month...No interest financing on Lasik, premium cataract lenses, cosmetic eyelid surgery, exams, contacts, glasses & more.
NO MINIMUM!

 

Order Contacts

Please reorder your contacts using this convenient form. We will contact you to confirm your order.

About You
Patient Name:
Last four digits of SSN:
Required for account verification
Birth Date:
Phone:
Email:
   
Contact Lenses
Lenses Needed (Quantity): Right:    Left:  
   
Insurance
  Will you be using your vision insurance to cover the cost of your contacts?
Insurance in name of:
Covered person's SSN:
   
Credit Card Info
Card Issuer:
Name on Card:
Card Number:
Expiration Date:
Security Code: What is this?
[If you prefer to pay by check, your order will be shipped upon receipt of payment.]
   
Delivery
You will pick up your new contacts.
We will ship your new contacts to the following address:
Address City/State Zip
   
Finally...
Additional comments or instructions:
Thank you for giving us the opportunity to serve you!

  

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