Contact Lens Reorder Form

If you have previously ordered contacts from our office please fill in the following information. Most contact lens orders will be filled in 1-3 days. You will be emailed or called when your lenses arrive or feel free to contact the office after a few days. An eye exam is recommended before reordering if your last exam was more than 12 months ago.

Last Name (required)

First Name (required)

Email (required)

Day Time Telephone(required)

 Disposable Contact Lenses

Right Eye

Left Eye

 Permanent Contact Lenses

Right Eye

Left Eye

 Include Cleaning Solutions

Delivery Type




Postal Code