Order Contact Lenses

If you would like to place an order for contact lenses, please complete the following form.

We will be happy to mail them to you or you can pick them up at our office. One of our staff will call you to confirm your order.


Title

Full Name*:

Date of birth*:

Telephone*:

Email*:

for confirmation email only, will not be given to a third party.

Which eye(s)*:

Quantity*:

Pick-up Location*:

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