ORDER CONTACT LENSES

If you are a current patient and have had an eye examination within one year, and if you have not already ordered a complete year's supply of contact lenses, you may order lenses here.

PATIENT INFORMATION (* - Indicates required fields)
Patient Name:* Pls enter your name.(First, MI, Last)
Date of Birth:* DOB is required.e.g. (mm/dd/yyyy)
Order:* Vials Boxes (select one)
Quantity of Lenses:
EYE
QUANTITY
Right
Left
If Boxes Ordered

6 month supply
1 year supply

Pick up contact lenses at: Pleasanton Livermore (pls pick one)

DAYTIME PHONE: (925) 460-5000

Please allow approximately 5-7 business days for orders to be filled. We will notify you when your order arrives and if they are on back order.

If interested in direct shipment, orders must be paid in advance. Please call (925) 460-5000 to place an order for this service.

* Do you have vision benefits to use towards the purchase of this order?

yes no

* Name of Vision Plan: Please select an item.

All lenses must be picked up within 2 weeks of notification. Payment in full is due when lenses are dispensed. We accept cash, check, VISA®, MASTERCARD®, or DISCOVER®.

Please notify me when the lenses arrive at:

* e-mail (Enter a valid email address here).

* phone (with area code)

If there is a problem with any aspect of your order, we will notify you. Thank you!

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