Contact Lens Order Form

You can order contact lenses through us by completing the form below. Be sure to click on the Submit Order Request button when you're finished. Our staff will contact you within one business day to confirm your order and payment information.

If you prefer, you can also order contact lenses by calling us at (508) 381-5600.

Fields marked with an "*" below are required.

* First Name
* Last Name
* Address
* City
* State
* Zip
Day Phone
Night Phone
* Email Address
Contact Lens Brand/Type
Desired Quantity (by monthly supply or number of boxes)	or
* Preferred Delivery Method	Ship to home (We will contact you for payment information prior to ordering.) Pick up at clinic
* Additional Notes

	*Required Fields