Contact Lens Order Form

Please Note: In order to complete any contact lens order, patients must have had a contact lens evaluation within the past calendar year with updated lens information on file. Otherwise, please call our office  if you need to schedule an appointment.

If you would like to preview our CL price list, please click on the link below. Prices are set at per lens/box pricing. Some manufacturers offer mail-in rebates, ranging from $30 - $80, for disposable supplies that are ordered in 6 month or yearly quantities. These will automatically be sent with your order.

  • Order Information

    For non-disposable Contact Lens wearers:
  • For disposable Contact Lens wearers:
  • *Most brands package 6 lenses/box
  • *Most brands package 6 lenses/box

  • Personal Information

  • MM slash DD slash YYYY

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