Name:
Phone number:
Number of boxes to order for
your LEFT EYE:
Number of boxes to order for
your RIGHT EYE:
Please check how you would like to receive your contacts (choose only one):  
I will pick up my contacts in the office.
Please ship my contacts to me at the address below ($3.00 charge applies)
Address Line 1:
Address Line 2:
City, State, Zip:
Comments or
other information:
Please note that if you choose to pick up your contacts in our office, we will call you when they are ready.  
If you choose to have your contacts shipped to you, we will ship them within 2 business days if they are in stock.  Most
contacts that need to be ordered will ship within one week.  Please call us at (920)743-5053 if you have any questions!
Be sure to click the button below to place your order.

If you are an established patient who would like to order
contact lenses on-line, please fill out the form below.  
New patients, please call (920)743-5053 and we would be
happy to help you.  Thank you!
Order Contacts