Order More Contact Lenses

Patients of Dr. Chow and Associates can use this form to order more contact lenses online. If you would like a different type of contact lens from your last purchase, please contact us to discuss your options.

Ordering Instructions

  1. Complete the form below
  2. Our office will contact you when your order is ready
  3. You can pick up your order and make payment during office hours

Your Full Name


First

Last

How should we contact you when your order is ready?


Your phone number
or

Your e-mail address

How many pairs of lenses do you want?

For regular contacts
or
For dailies (daily disposable) contacts

Add solution to your order?

Yes - include solution

Question or comments about your order? (optional)



For your privacy, please do not send sensitive medical or financial information using this form.

What is

?


(This helps us reduce spam)


Thank you for your order!