CONTACT LENS ORDER FORM

This service is only available to current contact lens patients.

For those who have not purchased contact lenses from our clinic, please contact our office at (905) 860-6000.

If you have purchased contact lenses from us before and would like to replenish your stock, please fill out the following form and we will contact you when the lenses arrive.

Name

First Name

Last Name

Email Address

Mailing Address

If you'd like us to ship it to your home/other location at no charge

Phone Number

We will call you to confirm the total amount & collect payment

Contact Lens Information

Please let us know the brand & quantity you'd like to order. Example: 1 year supply of Dailies Total 1