EmailThis field is for validation purposes and should be left unchanged.First Name*Last Name*Address 1*Address 2City*Province*Postal Code*Phone #*Email* Quantity* 1 year supply 6 months supply 3 months supply Insurance* I would like my insurance billed I do not have insurance or do not want to bill it Delivery* I would like my contact lenses delivered to the above address. One of our staff members will contact you to finalize the order. Pick up contacts in clinic. A staff member will contact you when the order has arrived. CommentsCAPTCHA
