Reorder Contacts

Thank you for choosing the Laurel Eye Clinic for your contact lens needs. This form is intended for the use of existing patients with current contact lens prescriptions. Please obtain the information for this form from your current contact lens boxes. If there are any questions or discrepancies in your order, a member of our staff will contact you by phone to verify. Please keep in mind that your contact lens prescription is only valid for one year. If your examination was over 1 year ago, you will be asked to schedule an appointment. If you are a new patient, please click the request appointment button on the left and we would be happy to assist you in scheduling an examination.

Right Eye -

Left Eye -

Number of Boxes -

(Select office below)

(additional shipping charge of $6.50 applies)

Credit Card Information

Credit Card (Choose One) -

Note: Upon submission of this form, your credit card order will be manually processed after your contact lens prescription has been verified. Confirmation will be sent via e-mail within 2 business days.

 

 

ALTOONA • BROOKVILLE • CLEARFIELD • DUBOIS • GROVE CITY • JOHNSTOWN • NEW BETHLEHEM • PUNXSUTAWNEY • SENECA

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