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Flaum Eye Institute / Optical Services / Contact Lens Order Form

Contact Lens Order Form

We offer a convenient way to order contacts. Use the form below and we will provide you with a quote for our lowest price on your lenses within two business days. We'll also check your insurance and look for special rebates to save you even more. Please be aware that this form is not for re-ordering specialized medical contact lenses such as scleral lenses or PROSE.

One-year supply orders qualify for FREE shipping. Shorter-term orders may be subject to shipping and handling charges.

Format: YYYY
Patient Age:

Are You a Patient of the Flaum Eye Institute?:
Where Did You Receive Your Contact Lens Script?:

Do You Plan to Use Your Vision Benefit Toward Your Purchase?:

Contact Me By: