Contact Lens Order Form

Please use the form below to place an order request.  We will contact you for payment and shipping/pick-up details prior to ordering the lenses.


For patients with contact lens prescriptions from another provider, please email us your prescription (a photo or a PDF copy) to

* Please Note:  Only valid contact lens prescriptions will be accepted.  If your contact lens prescription is expired or you do not have a contact lens prescription, please book an eye exam.

Supply Amount
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