Name(Required)Email(Required) Mon.-Fri. 9:00 AM to 6 PM, Sat. 9:00 AM to 3:00 PM, Sunday Closed This is only a request for an appointment. Actual date and time of appointment will be scheduled by our office using the information provided.Preferred day of the week:-Select One-MondayTuesdayWednesdayThursdayFridaySaturdayPreferred time of day: Number of Appointments needed (e.g., for additional family members) Day Phone:*(Required) Do you have any eyecare insurance Yes No If so, what insurance do you have? Question/Comment5 + 7 =(Required)Please enter a number from 5 to 12.Please enter a number that represents 5 + 7CAPTCHA Δ
Name(Required)Email(Required) Day Phone:(Required)The number of boxes of contacts you would like to order(Required) Date needed: The contact lens manufacturer can ship the lenses directly to your home or office, or you can pick them up at the office during regular business hours.Shipping: Ship to me Pick-up *Please Note: There is a federal law governing the expiration of a contact lens prescription. We will verify your prescription expiration date before calling you about your contact lens order.3 + 5 =(Required)Please enter a number from 3 to 12.Please enter a number that represents 3 + 5CAPTCHA Δ