If you have purchased contact lenses from our office in the past, and need to re-order, please fill out the following form:

Name
Date of Birth
Daytime Phone
Email
Contact me by	Daytime Phone Email
I would like to purchase 6 months or 12 months of contact lenses.
Questions
Which type of Contact Lens Solution do you currently use? Please Check One.
Clear Care Renu Complete Sensitive Eyes Other
Please Note: If it has been over 1 year since you have been seen by Dr. Lafleur or Dr. Dionisio you will require an eye exam before we are able to order your contact lenses

If you have any trouble with this online order form, please contact us or drop by the clinic.