Contact Lens Order Form Contact Lens Order Form Please fill out the form below to order contact lenses. Our office fills orders for 3, 6 and 12 month supplies. Remember all annual supply lens orders are eligible for mail in rebates and can be shipped at no charge. Name*FirstLast Type of Contact Lenses:*Select valueAcuvueBiofinity Email* How many Boxes?:*Select value3 month supply6 month supply12 month supplySubmitReset
