Contact lens order

Our office provides two convenient ways of ordering Contact Lenses. You can either phone our office (905) 892-5191 or fill out the form below. Our staff is ready to assist you. All the fields followed by a * are mandatory.

Referred by
Title
First Name*
Last Name*
Phone ((###)###-####)*
Alternate phone ((###)###-####)
Email*
Do you want to be contacted by email or phone?
- Email
- Phone
Date of birth*
When was your last eye exam?
Type of lenses required*
Please name the product.
Eyes*
- Left
- Right
- Both
Quantity
- 1 year
- 6 months
- 3 months
Or number of boxes
Message / Comments

Address & telephone

Hours