Wufoo

Name * First Last
Phone Number *
Email
Your Optometrist
Dr. M. Hurlbert Dr. A. Lennox Dr. I Koh
Reorder Quantity *
annual supply of contact lenses (4-8 boxes) and solutions annual supply of contact lenses only (4-8 boxes) a different amount (please specify below)

We will fill your order using your current prescription.
You must have had an eye examination at our office within the past 2 years.
Pick up/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 604-463-4469.
Shipping address if different from home address
Additional comments/special requests
Do Not Fill This Out

Wufoo Powered