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Order Contacts
Please complete the form to submit your order for contact lenses. Our staff will contact you by phone to complete the transaction via credit card. We will need to verify the contact lens information and ensure that your prescription is up-to-date by checking your file.
Name
*
First
Last
Phone
*
Would you like to be contacted by email?
*
Yes
No
Email
*
Are you currently a patient of the Family Eye Care Center?
Yes
No
1 Day CLs
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2 Week CLs
3 Month Supply
6 Month Supply
12 Month Supply
One Month CLs
6 Month Supply
1 Year Supply
Message
List any difficulty experienced with the contacts (decreased comfort, redness, dryness, decreased vision). If the lenses are not performing as needed, please inform us. We can see you for a contact lens check (which was included with your original exam fee).
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