Contact Lens Order Request

To receive contact lenses, please complete the form below. Once we receive your request, our staff will verify that your contact lens prescription in our records is up-to-date. Within 8 business hours of receiving your request, we will call you with the cost of your order, available delivery options, and to collect payment to complete the transaction.

Name:
E-mail address:
Best phone number during business hours:

Select the quantity of lenses you'd like for each eye:
Right eye:
Left eye:

Anything else we need to know?