Order Contact Lenses Online Contact Lens Reorder Form Name* First Last Daytime Phone*Date of Birth Month Day Year How many boxes per eye?Right Eye*01234567891112Left Eye*01234567891112Delivery OptionsOption 1 - Ship Direct to You - Please Provide AddressLab Shipping Charge - $15.00 - Our office will contact you for payment information to protect your privacy. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Option 2 - Pick Up In Office - Please Select OneWe will contact you once your order has arrived and payment will be due at time of pick-up. Chillicothe Greenfield Waverly Payment InformationIf you have chosen to have your contact lenses shipped directly to you, our office will contact you for payment information to protect your privacy. If you have chosen to pick up your contact lenses at one of our 3 locations, we will contact you once your order has arrived and payment will be due at pick-up.CommentsThis field is for validation purposes and should be left unchanged.