Contact lens order

Please fill in all required fields below and we would be happy to refill your contact lenses.
Contact lens wearers require annual health and contact lens evaluations to maintain optimal comfort, vision and health.

First name *

Last name *

Date of birth

Day time telephone *

E-mail *

Type of lenses required *
Name of product :
 Right eye Left eye
Quantity :  1 year 6 months Refill my last order

Do you need contact lens solutions *
 yes no
Quantity :  1 year 6 months Refill my last order

Comments

Would you be interested in being kept informed of clinic promotions, offers or updates?  yes no