Contact Lens Order Form

Name: Performance Vision Care – Sandusky
Address: 5005 Milan Road, Sandusky, OH, 44870, US
Telephone: 419-625-7904
Price range: $000 - $300

Need new contacts? Fill out our secure order form above, and we’ll get your lenses to you as soon as possible!

APPOINTMENT DATE:*
MM slash DD slash YYYY
Your Practice*
- Independence
- Sandusky
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Best Method To Reach You*
Email Address
Contact Lens Order Amount*
- 6 months
- 1 year
- Other
Other
How 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

Performance Vision Care – Independence

Performance Vision Care – Sandusky