Please fill out the following form to re-order contact lenses. Required fields are marked with asterisks (*).
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We must have a valid prescription for you on file. If we do not, please make an appointment with us for an eye exam. And YES, we can fill valid contact lens prescriptions from another office. Just fax your order to 360-253-2233.
Patient Name(Last, First, Middle Initial): *
Home Phone: *
Work Phone: *
Email Address: *
How do you prefer to be contacted? *
Have you visited our office before? *
Orders will be evenly split between right and left eyes unless otherwise indicated.Click here to see our price list. For rigid gas permeable lenses or for soft contact lenses not listed, please call our office at (360) 253-4405.Money-saving Mail-in Rebates are available on most annual supply orders.
Again, we can fill valid contact lens prescriptions from another office if you fax your order to 360-253-2233.
Quantity being ordered: *
-select-1 box2 boxes3 boxes4 boxes5 boxes6 boxes7 boxes8 boxes
-select-Spherical - Bausch & Lomb - Purevision 2Spherical - Ciba Vision - Air Optix AquaSpherical - Ciba Vision - Air Optix N&D AquaSpherical - Cooper Vision - Proclear CompatiblesSpherical - Vistakon - Acuvue OasysToric Soft Lenses - Bausch & Lomb - Softlens ToricToric Soft Lenses - Bausch & Lomb - Purevision 2 ToricToric Soft Lenses - Ciba Vision - Ciba Dailies Toric (30 pack)Toric Soft Lenses - Ciba Vision - Ciba Dailies Toric (90 pack)Toric Soft Lenses - Cooper Vision - Proclear ToricToric Soft Lenses - Cooper Vision - Acuvue Oasys for AstigmatismToric Soft Lenses - Cooper Vision - Acuvue 1 Day Moist Toric (90 pack)Colored Contact - Vistakon - Acuvue Colors (Enhancers)Colored Contact - Vistakon - Acuvue Colors (Opaque)Multifocals - Bausch & Lomb - Softlens MultifocalMultifocals - Bausch & Lomb - Purevision MultifocalMultifocals - Cooper Vision - Proclear MultifocalMultifocals - Cooper Vision - Frequencey 55 MultifocalMultifocals - Ciba Vision - Air Optix MultifocalHeck Dr. J, I don't know, can you check my records?I don't see my choice listed.check records please.
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Please select a shipping option: *
I will pick up the lenses at the officeShip to the address below (shipping fee may apply)
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Required if order is to be shipped to you.
Credit Card Number:
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