Please reorder your contact lenses through our website!

Name

First Last

Phone

Email

Your Optometrist

Dr. Beth Lennox
Dr. Amanda Brown
Dr. Sarah Schaffels
Dr. Kaylee Wood

Healthy Eyes Plan Reorder Quanity

6 month supply of contact lenses & solutions
12 month supply of contact lenses & solutions
a different supply of contact lenses-specify supply below

We will fill your order using your current prescription. [You must have had an eye examination at our office in the past 2 years]

Amount if other than 6 or 12 months

Pickup/Delivery Options

I will come to the office to pick up
please ship to my office address- shipping fee may apply
please ship to my home address-shipping fee may apply

For shipping options, we will contact you for payment information. Your contact lenses will normally arrive in 2-3 business days. If you haven't received them after 4 days please contact our office at 519-624-2020.

Shipping Address if different then home address

Additional Comments/Special Requests

Thanks for ordering your contact lenses through our website! We look forward to seeing you soon!

Phone

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Contact Lens Reorder Form

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