Time to reorder contact lenses? Complete the form below and we will process your order as soon as possible.

The online order process is simple.

After we receive your order request we will verify that you have a current prescription on file (within the past year).
If your prescription is eligible, you will receive an email containing a link for payment and delivery options.
If your prescription is not eligible, you will receive an email with a link to our online eye exam scheduling
page prior to receiving new contact lenses.

Fields marked with a * must be filled out for us to process your order.

CONTACT INFORMATION*
Name:
Address:
City:	State:	Zip:
Email:	Phone:
Preferred method of contact: Email Phone

ORDER INFORMATION*

Brand of Contact Lenses: Select a brand... Acuvue Bausch & Lomb Ciba Cooper Select a brand...

Number of Boxes: Select a quantity... 1 2 4 8

What location did you last purchase contacts from? Bristol EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & FRIDAYS Canton EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & SATURDAYS Enfield Square EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & SATURDAYS Farmington EXAMS AVAILABLE: MONDAYS - FRIDAYS & SATURDAYS Glastonbury EXAMS AVAILABLE: MONDAYS, TUESDAYS,THURSDAYS & SATURDAYS Hartford—Downtown EXAMS AVAILABLE: MONDAYS - FRIDAYS Hartford Hospital EXAMS AVAILABLE: MONDAYS,WEDNESDAYS & FRIDAYS Kensington EXAMS AVAILABLE: WEDNESDAYS & SATURDAYS West Hartford EXAMS AVAILABLE: MONDAYS, TUESDAYS, THURSDAYS & SATURDAYS

How did you hear about us? * Select Referral Billboard Facebook Other Online

NOTES

Please use this space to indicate preferred doctor or other special needs/concerns.

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