Order Contact Lenses

In order to process your request, we must have a valid prescription for you on file.

After you click “Submit,” please be sure to wait for the confirmation message before moving to another page or closing your browser.

Thanks for submitting your order.

We will call you with any questions.

    Your Information:

    (*Required Fields)

    Patient's Name*

    Patient's Date of Birth*

    Your Name (if different than patient)

    Relationship to Patient

    Day Time Phone Number*

    Email Address*

    Mailing Address*

    Preferred Method of Contact

    EmailPhone

    Preferred Method of Delivery*

    Your Order:

    Quantity Right Eye*

    Quantity Left Eye*

    Additional Information:

    Your information will be used by Ross Eyecare only. It will never be shared or sold.