Please fill out the form below and a staff member will contact you at their earliest opportunity. This is NOT a contact lens order, nor do contact lenses get ordered automatically from filling out this request. This is a form that gets sent to office staff, to request a new order or supply of contact lenses . Our doctors very much want to make sure your eyes are healthy. Therefore, they may need to see you before an order gets put through (our staff will advise you if this is necessary) Please be aware that if you are requesting a contact lens order before a long weekend or holiday, you may contacted once the office has reopened from these times of closure.

Fields followed by * are required.
  • General Information

  • Prescription

  • Please name the product (e.g. Acuvue Oasys)

  • Solution

  • Additional Information, Comments, or Questions