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Home
About
- Our Practice
- Meet the Doctors
Services
Patient Center
Contact Us

Order Contacts

Contact Lens Order Request For

Patient Information

First Name*

Last Name*

Date of Birth

Phone Number*

Email Address*

Prescription Information

When was your last eye exam with us?*

Within the last yearOver one year agoNot sure

Is this the same contact lens prescription you ordered last time?*

YesNo

Contact Lens Details
Brand Name (if known)

Type

DailyBi-WeeklyMonthlyToric (for astigmatism)Multifocal

Power (OD / Right Eye)

Power (OS / Left Eye)

Quantity Requested

1 box per eye2 boxes per eyeOther (please specify)

Delivery Method

Preferred Method*

Ship to homePick up in officeShipping Address (if applicable)

Insurance & Payment

Will you be using vision insurance for this order?*

YesNo

Additional Notes

Acknowledgment

I understand that my prescription must be valid to place a contact lens order and I may be contacted if additional information is needed

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Contact Information

3087 Dundas St.
West Toronto, ON M6P 1Z9

(866) 889-0772

Hours of Operation

Monday 10:00am - 7:00pm
Tuesday 10:00am - 7:00pm
Wednesday 10:00am - 7:00pm
Thursday 10:00am - 7:00pm
Friday 10:00am - 7:00pm
Saturday 10:30am - 6:30pm
Sunday 12:00pm - 5:00pm

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Home
About
- Our Practice
- Meet the Doctors
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Patient Center
Contact Us

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