Contact us at: (403) 233-0405
Services
Facilities
Team
Eye Health
Glasses
Contact Lenses
Contact
Contact Lens Reorder Service
Contact Lens Reorder Service
OA7960
2017-08-24T08:20:34+00:00
Please fill out the form below and a staff member will contact you within 1 business day to confirm the details of your order and arrange payment
Fields followed by * are required.
General Information
Name
*
First
Last
Phone
*
Email
Date of Birth
Date of Last Eye Exam (only required if your last eye exam was performed elsewhere).
Name of Eye Doctor
Prescription
Type of Lens
*
Please name the product (e.g. Acuvue Oasys)
Eye
OD (Right)
Power
*
-12.00
-11.50
-11.00
-10.50
-10.00
-9.50
-9.00
-8.50
-8.00
-7.50
-7.00
-6.50
-6.25
-6.00
-5.75
-5.50
-5.25
5.00
-4.75
-4.50
-4.25
-4.00
-3.75
-3.50
-3.25
-3.00
-2.75
-2.50
-2.25
-2.00
-1.75
-1.50
-1.25
-1.00
-0.75
-0.50
-0.25
0.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
+6.50
+7.00
+7.50
+8.00
BC
*
8.2
8.4
8.6
8.8
9.0
DIA
13.8
14.0
14.2
QTY
*
1
2
3
4
5
6
7
8
9
10
11
12
Eye
OS (Left)
Power
*
-12.00
-11.50
-11.00
-10.50
-10.00
-9.50
-9.00
-8.50
-8.00
-7.50
-7.00
-6.50
-6.25
-6.00
-5.75
-5.50
-5.25
-5.00
-4.75
-4.50
-4.25
-4.00
-3.75
-3.50
-3.25
-3.00
-2.75
-2.50
-2.25
-2.00
-1.75
-1.50
-1.25
-1.00
-0.75
-0.50
-0.25
0.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
+6.50
+7.00
+7.50
+8.00
BC
*
8.2
8.4
8.6
8.8
9.0
DIA
13.8
14.0
14.2
QTY
*
1
2
3
4
5
6
7
8
9
10
11
12
Solution
Type
Quantity
or quantity for
6 months
1 year
Additional Information, Comments, or Questions
Phone
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