Contact Lens Reorder | Woodstock Optometrist - Drs. Brant,, Khanna & Thornton

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Today's Date* This field is required.

Date

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Your Name* This field is required.

First Name

Last Name

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Phone Number* This field is required.

Area Code

Phone Number

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E-mail Address* This field is required.

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Delivery Method* This field is required.

Lenses will be shipped directly to your or home/office.

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Shipping AddressWe'll gladly mail you the contact lenses directly to your home or office.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Would you like to re-order the lenses you ordered previously or the new ones that you were trying?* This field is required.

Please re-order the same lenses that I ordered last time

Other

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How many lenses do you want to order?* This field is required.There is an additional savings with the purchase of an annual supply from the lens companies.

Annual Supply

6 month supply

90 day supply (daily disposable lens only)

30 day supply (daily disposable lens only)

Other

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Would you like us to direct bill your insurance?* This field is required.

YESNO

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You will be contacted by e-mail after submission. At present time we are taking payment via e-transfer, direct billing or by credit card. Your order will be shipped to the address you supplied in the form.