Order Contact Lenses

If you had a contact lens evaluation from us within the past 12 months and would like to order additional or replacement contact lenses, you may order contact lenses online using the form below, or call us at 413-283-2946.  For your convenience. we can have your new lenses mailed to your home or workplace.

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

After submitting this form, we will contact you for your credit card information for payment.

Personal Information:

First Name: Middle: Last Name: (required)
Street:
City: State: Zip:
Birthdate: MM/DD/YYYY (required)

Contact Information:

Home Phone:
Work Phone:
Cell Phone:
Email Address: (required)
Contact Preference: Home PhoneWork PhoneCell PhoneEmail

Contact Lens Information:

Type of Contact Lenses: Disposable Soft Contact LensesGas-PermeableConventional Soft LensesCRT Lenses
Right Eye Quantity:
Left Eye Quantity:
Delivery Preference: I will PickupMail them to me

Additional Information, Comments, etc.: