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(604) 255-4728
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About Us
Our Team
Eye Care Services
Comprehensive Eye Exams
Pediatric Eye Exams
Eye Disease Management
Myopia Management
Dry Eye Disease Managment
Orthokeratology
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Appointment Request Form
Patient Registration Form
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Contact Lens Re-Order Form
If you are a patient of our office and would like to re-order contact lenses, simply fill out this form. We will match the prescription to what we have on file. You will be contacted within 24 hours to confirm the order.
Name
*
First
Last
Telephone
*
Email Address
Address (if you'd like it shipped)
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Province
Postal Code
Number of Boxes (i.e. 2 boxes per eye)
*
Anything else You'd like us to know.
Submit
2443 East Hastings Street, Unit 2, Vancouver, BC V5K 1Y8 »
(604) 255-4728
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