Contact Lens Order Form Need new contacts? Fill out our secure order form above, and we’ll get your lenses to you as soon as possible! Your Practice* Independence Sandusky Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Best Method To Reach You*SelectCallTextEmailEmail Address Contact Lens Order Amount* 6 months 1 year Other OtherHow would you like to receive your order? I'll pick it up. Ship it to me If you select “ship it to me” please watch for a text with a link to our payment portal. Order will be processed as soon as payment is completed
*Our Sandusky location is open the 1st and 3rd Saturday of every month, from 8 am until 1 pm
Please call our office to confirm that we are open that day.