If you are a current patient at our practice and you need more contact lenses, please use
the form below to contact us.
  • All orders will be shipped to the office unless you request otherwise.  
  • If you would like the contacts shipped directly to you, a $7.95 shipping charge will
    be applied. Or purchase a whole year's supply of lenses, and we will ship them for
    free.  
  • We need payment in full before we place the order. A staff member will call you for
    a credit card number, or you can stop in and pay at the office.
Your name:
Your email address:
Your phone number:
Patient name (if not you):
Number of boxes:
Will you be using insurance benefits?
Shipping address:
Comments: