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Order Contacts
 

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  To purchase Contact Lenses fill out the form below (We carry most major brands including Ciba, J&J Vision Care, Acuvue, B&L, Cooper Vision, Ocular Science, Boston, etc):                                                      

 

Filling out the form below will send e-mail directly to our Office!

Name?

Address?

How can we reach you? (phone, cell, pager)

e-mail address?

Are you a current patient at our office?
Yes
No

Check all the following that applies:
Please order the right contact lens. Specify quantity:
Please order the left contact lens. Specify quantity:
Order for both eyes. Specify quantity:
Order Revitalens  Bulk Pack. Specify quantity:
Order Aosept Bulk Pack.  Specify quantity:
Charge to my credit card on file. Please file my vision insurance claim.

Select one of the following preferences:

Your Comments Please?

Thank You