Annapolis Vision Center


About Us

What's Hot

Products

Services

Insurance Partners

Order Contacts

FAQ

Contact Us

 

  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  
Get Acrobat Reader(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!

 

1999 (c) Annapolis Vision Center, Inc.