Patient Portal

West CountyOphthalmology

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Order Contacts

To order contacts, you must have had an eye exam within the last year. New patients or existing patients who need to schedule an exam should call the office or Request an Appointment.

Order contacts online and save 10%. If you order an ANNUAL supply, you will save an additional 5%. A total savings of 15% by ordering online ONLY. Certain Alcon and Vistakon brands are excluded from the 15%. Free shipping!! Annual purchase of contacts includes a free pair of nonprescription sunglasses. No more squinting in the sun when you are wearing your contacts!

To order your contacts, complete the form below. One of our contact lens specialists will confirm the order on our next business day. If you have trouble completing the form, you may call our office at 314-878-9902 during business hours.


Name

Phone

Email

Date of Birth

Brand of Contacts

Contact Lens Power
Right:

Left:

Base Curve

Diameter

No of boxes per RIGHT eye

No of boxes per LEFT eye

Do you have vision insurance?
 yes no

If yes, name of insurance

Mailing address (unless ordering for pick-up)

City

Zip