ON-LINE CONTACT LENS ORDER FORM This service is available to any contact lens wearer with a VALID contact lens prescription. If you do not have a valid contact lens prescription, please contact us. For security purposes, you NEED to pre-register for this service either in the office or via fax service using your name and a major credit card. CLICK HERE TO PRE-REGISTER   (Adobe Acrobat File .pdf - 7.5K) CONTACT LENS ORDER REQUEST FORM * Required Fields *Name *Day time phone: Are you currently a patient with Annapolis Vison Center? Yes No If "No", your Dr.'s name: My pre-registration for online ordering is on file: Yes No (Click here to Pre-Register.) Please ship my contacts to: My home My office MY ORDER Disposable Contacts Planned Replacement Contacts Right Eye boxes. Left Eye boxes. **Shipping is free with a 4 box order of any Acuvue, Surevue or Vistavue lens! For any other brand, please add a $3.00 shipping fee for 1-3 box order, and $5.00 for 4 boxes or more. Non-disposable Contacts Right Lens Left Lens Pair Please add a $3.00 shipping fee. IF YOU HAVE NOT PRE-REGISTERED FOR THIS SERVICE, YOU ARE NOT ELIGIBLE. PLEASE, DOWNLOAD AND REGISTER WITH THE PRE- REGISTRATION FORM.		What is LASIK? Laser Assisted In-Situ Keratomileusis Find Out More About LASIK Eye Problems Are your contact lenses uncomfortable? Do your eyes burn, feel irritated, or tear alot? Find Out Why!

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