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contact lens refill orders
*
Indicates required field
Name
*
First
Last
Email Address
*
Your EMail Address.
Shipping Address
*
If your contact lens prescription is expired or not on file, please schedule an eye exam or notify us.
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If your contact lens prescription is from another office, provide the Doctor's name and phone number or fax the Rx to 973-543-6260
Right Eye Quantity
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1 Box
2 Boxes
3 Boxes
4 Boxes
Left Eye Quantity
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1 Box
2 Boxes
3 Boxes
4 Boxes
Shipping Option
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Ship to Office (Free Shipping)
Ship to me ($8.00 shipping or free if over 6 months supply)
Orders are Processed by 5 pm Business Days Only. Standard Shipping is usually 3 to 5 Business Days.
Submit to Insurance?
*
Yes, my Insurance is on File
We must have your Insurance on file
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