Contact Lens Order

For added convenience, you can now order replacement lenses online using our secure website. Please note that we supply replacement lenses for our own patients who have been examined by us within the past twelve months.

Please complete the following information. Once completed and submitted you will receive an e-mail confirming your order and payment amount.

Order Request Form

Fields marked with an * are required

Your Information

Billing Address


Please let us know if you will be using any insurance. Include any questions or comments regarding your order.

Shipping Address

(if different from address above)

Lens Request