Order Contact Lenses | ROCKLAND EYE CLINIC

Order your contact lenses

Name *

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Last

Email *

Telephone *

Address *

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Address Line 2

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Brand *

Rx Right *

Rx Left *

Base Curve (B.C.)

Comment *

Please note that you can only use this form if you already have a contact lens file at our clinic. All other orders will be voided. Please let us know preferred method of payment.

Total *

$ 0.00

Payment by Interac bank transfer or credit card over the phone. Please mention preferred mode of payment in Comment section.

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