Contact Lens Reorder Request Form
Please use this form to request a reorder of your contact lenses. Upon receipt of your request, we will contact you within five working days (Mon-Sat) to process your order and take payment.

**PLEASE NOTE: We are currently experiencing high demand so there may be a small delay in response.**

Please note in order to successfully complete your order, your Contact Lens and Eye Examination prescriptions must be held with Leightons and be in date.

Your email address is collected in order to provide a confirmation email, and is not passed to any third party. Please see our privacy notice for full details.
Email address *
First Name *
Your answer
Last Name *
Your answer
Postcode (Home Address) *
Your answer
Date Of Birth *
MM
/
DD
/
YYYY
Contact Phone Number *
Your answer
What would you like to order? *
Your Preferred Branch *
Please add any other useful information to support this request. **PLEASE NOTE: If you are a key worker, please state this here.**
Your answer
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