LENS ORDER
 

We invite you to order your replacement contact lenses via our Web site.  Fill in the information below and when the order is received we will mail your contact lenses, or hold them at the office for pick up.  Your request will be confirmed by phone or e-mail.

 

First Name :

Last Name:

Address1:  

Address2:  

City:          

State:       Zip Code:

Type 

Brand

Quantity Left Eye    Quantity Right Eye 

Please mail my contact lenses ($5.00 additional charge)
Please hold for pick up

 

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