Order Contact Lenses

Please fill out this Contact Lens Request Order form.

We’ll do our best to get back to you within the day to place your order. (If you need immediate action, please call us at 212-366-1010)

Please complete the form below

Name *
Name
Phone *
Phone
Alternate Phone
Alternate Phone
Are you an existing patient? *
(if you are a new patient or have your own Rx easily accessible, please attach it, otherwise we will look it up in our patient database)
Delivery Preference
Shipment Method
If you chose "direct shipping" , please specify shipping method.
Please write the desired brand and quantity of boxes for each eye. If you are picking up in the store, you can pay on pickup, and if we are shipping to you, our contact lens department will contact you for payment. Please do not put your credit card number in the notes.