eye infections Ocular Health Management Cataracts https://youtu.be/d5D0B2PoC7 Glaucoma , Macular Degeneration, Diabetic Retinopathy, Hypertensive Retinopathy, Corneal Dystrophies, Double Vision, Eye Infections, Styes, Foreign Body Removal, Ocular Rosacea Contact Lens Order Form Already a patient? Re-ordering your lenses is easy! Simply fill out the form below and we will contact you to confirm your order and process payment securely. Name* First Last Email* PhoneDirect Shipping Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reorder Quantity1 Year Supply6 Month3 Month (Dailies only)*Note: Volume discount and rebates apply only to 6 and 12 month supplies.Pickup/Delivery OptionsShip--Please Select--YesNo*Shipping charges may applyShipping Address(if different from home address) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional Comments/Special RequestsBillingUse Vision Insurance?YesNo
Ocular Health Management Cataracts https://youtu.be/d5D0B2PoC7 Glaucoma , Macular Degeneration, Diabetic Retinopathy, Hypertensive Retinopathy, Corneal Dystrophies, Double Vision, Eye Infections, Styes, Foreign Body Removal, Ocular Rosacea
Contact Lens Order Form Already a patient? Re-ordering your lenses is easy! Simply fill out the form below and we will contact you to confirm your order and process payment securely. Name* First Last Email* PhoneDirect Shipping Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reorder Quantity1 Year Supply6 Month3 Month (Dailies only)*Note: Volume discount and rebates apply only to 6 and 12 month supplies.Pickup/Delivery OptionsShip--Please Select--YesNo*Shipping charges may applyShipping Address(if different from home address) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional Comments/Special RequestsBillingUse Vision Insurance?YesNo
