Wufoo

Name First Last
Phone Number ### - ### - ####
Email

Please include an email address to receive confirmation of your order.
Your Optometrist
Dr. Melanie Sherk Dr. Cindy Anderson Dr. Tracy Ertel Dr. Tracey Curry Dr. Sally Donaldson Dr. Eva Kalicinsky
Reorder Quantity
6 month supply of contact lenses 12 month supply of contact lenses
Additional Comment or Special Requests
Thank you for ordering your contacts through our website!
If you've included your email address, you will receive a confirmation email.
If for any reason we cannot process your order we will call you, otherwise we will call you when your contacts are ready for pick up.
We look forward to seeing you soon!
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