Fill out this order form so we can evaluate your request. We will call you to confirm your payment method & order requirements. If you have any questions, please give us a call.
Which eye(s) are you ordering contacts for
Vision Insurance Info (Optional)
Enter plan provider and your ID #
(Note: Medicaid does not cover contact lenses)
Eagle Glen's Eye Doctor and Staff Provide
Quality Eye Care and Personalized Service You Can Trust