Order Contact Lenses

Name: University Optometry
Address: 725 University Avenue, Suite A, Palo Alto, California, 94301-2148, United States of America
Telephone: +1-650-329-1600
Price range: $000 - $300

Contact Lens Order Form

Patient Name*
First Last
Email*
Phone*
Pick Up or Delivery*
- Pick Up
- Delivery
There will be an $8 shipping charge for Delivery orders.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do We Have Your Prescription On File?*
- Yes
- No
Upload Your Prescription*
Accepted file types: pdf, jpg, png, gif, doc, docx.
RIGHT EYE: How many boxes/lenses would you like?*
Please enter a value between 0 and 30.
*ability to order lenses/boxes will be subject to prescription expiration”
LEFT EYE: How many boxes/lenses would you like?*
Please enter a value between 0 and 30.
*ability to order lenses/boxes will be subject to prescription expiration”
Comments
This field is for validation purposes and should be left unchanged.