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Optimum Vision Care Contact Lens Order Form
Please fill out this Google form to request a contact lens order with us. Once we receive your submission, we will contact you as soon as we can. Thank you.
What is your name?
If you would rather be contacted via text, please leave your phone number here.
Are you an existing patient?
No (you must send us a current valid prescription)
Would you like to apply your vision benefit to this order?
Maybe (still deciding)
Do you want to have this order shipped to you?
Yes (we will verify your preferred shipping address with you)
No (pickup at office)
Is there anything else you would like to let us know?
Do you have any questions?
Send me a copy of my responses.
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