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.

Contact Lens Price List (click here)

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Order Information:

 
For non-disposable Contact Lens wearers:
 
I would like to order: 1 lens Right eye
     
  2 lenses (both eyes) Left eye
 
For disposable Contact Lens wearers:  
 
I would like to order: Box(es) Right eye Box(es) Left eye
 
*Most brands package 6 lenses/box
 

 

Personal Data:

 
*Name:
*DOB: (mm/dd/yyyy)
*Address:
 
*Note Lenses Cannot be shipped to P.O. boxes.
 
*City:  *State:  *Zip:   
*Email:
*Phone:
 
I would like to pickup lenses: go to Flemington office go to Clinton office go to Bridgewater office
 
 

Special Order/Instructions:

 
 
  I would like to receive LASIK information
 
 

Live Surgery Lasik Open House

Dr. Paul Phillips


Thursday, October 26, 2017 6:00-7:30 PM

2018 Dates:  01/25/2018, 4/26/2018, 7/26/2018, 10/25/2018

6B Minneakoning Road Flemington, NJ 08822

One discount per surgery

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Locate Our office

Bridgewater
Tel: 908-526-4588
Fax: 908-231-6718
1 Monroe St.
Bridgewater, NJ 08807
click here for hours & directions
Flemington
Tel: 908-824-7144
Fax: 908-968-3239
6B Minneakoning Rd
Flemington, NJ 08822
click here for hours & directions
Clinton
Tel: 908-735-4100
Fax: 908-735-7494
64 Walmart Plaza
Clinton, NJ 08809
click here for hours & directions

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