Home
About Us
The Practice
Our Doctors
Our Team
Office Tour
Education
Services
Eyewear
Order Contact Lenses
Dry Eye
What is Dry Eye?
Diagnostics
Dry Eye Treatments
Treatment FAQ
Treatment Testimonials
Dry Eye Intake Form
Careers
Contact Us
Contact Lens Order Form
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
Province
*
Postal Code
*
Phone #
*
Email
*
Quantity
*
1 year supply
6 months supply
3 months supply
Insurance
*
I would like my insurance billed
I do not have insurance or do not want to bill it
Delivery
*
I would like my contact lenses delivered to the above address. One of our staff members will contact you to finalize the order.
Pick up contacts in clinic. A staff member will contact you when the order has arrived.
Comments
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
