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LASIK, Contact Lenses, Eyeglasses
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Contact Lenses
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Eyeglasses
Pediatric Eye Care Specialist
Optometrist, Colorado Springs
...
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Patient
Information
Disposable Contact Lenses
Select Lens
My Last Lens Type
I don't know, see notes below
Acuvue 1 day , 30 pack
Acuvue, 6 pack
Acuvue 2, 6 pack
Acuvue Bifocals, 6 pack
B & L 2 Week, 6 pack
Biomedics 38%, 6 pack
Biomedics 55%, 6 pack
Focus Colors 1-2 week, 6 pack
Focus Dailies, 10 pack
Focus Dailies, 30 pack
Focus Dailies, 90 pack
Focus Toric Monthly, 6 pack
Focus Soft Colors 1-2 week, 6 pack
Focus Soft Colors Monthly, 6 pack
Focus visitint 1-2 week, 6 pack
Focus visitint Monthly, 6 pack
Frequency 38 DW, 6 pack
Frequency 55 Aspheric, 6 pack
Frequency 55 FW, 6 pack
Fresh Look Colors, 6 pack
Fresh Look ColorBlends, 6 pack
Fresh Look ColorBlends Toric, 6 pack
Fresh Look Enhancers, 6 pack
Fresh Look Handleling, 6 pack,
Fresh Look Toric, 6 pack
Gentle Touch, 6 pack
Multiples Spheres, 3 pack
Multiples Toric Div 1, 4 pack
Multiples Toric Div 2, 4 pack
Occassions Bifocal 4 Pack
Optima FW, 6 pack
Optima FW, 30 pack
Perspecta, 6 pack
Precision UV Handling Tint, 6 pack
Preference FW, 4 pack
Preference STD, 4 pack
Preference STD Single DW
Preference Toric, 4 pack
Preference Toric XR, 4 pack
Preference XR Single
Proclear Compatibles, 6 pack
Sequence 1, 6 pack
Sequence 1, 13 pack
Softlens 1-Day, 15 pack
Softlens 1-Day, 90 pack
Soft Lens 66, 6 pack
Softlens 66, 30 pack
Softlens 66 Steep/Med, 6 pack
Softlens 66 Flat/Med, 6 pack
Soft Lens 66, Toric, 6 pack
Surevue, 6 pack
Color
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12 Boxes
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or
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Monthly Supply
1 Month Supply
2 Month Supply
3 Month Supply
4 Month Supply
5 Month Supply
6 Month Supply
7 Month Supply
8 Month Supply
9 Month Supply
10 Month Supply
11 Month Supply
1 year Supply
Left
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By Box
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5 Boxes
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8 Boxes
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10 Boxes
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or
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Monthly Supply
1 Month Supply
2 Month Supply
3 Month Supply
4 Month Supply
5 Month Supply
6 Month Supply
7 Month Supply
8 Month Supply
9 Month Supply
10 Month Supply
11 Month Supply
1 year Supply
Contact Pictures and Information
..
Daily Wear Contact Lenses
Select Lens
My Last Lens Type
I don't know, see notes below
AquaFlex Standard
Aquaflex Superthin
B&L O3
B&L O4
CibaSoft SoftColors
CibaSoft Visitint
CSI Daily Wear
CSI Daily Wear Toric
CSI Flexible Wear
CSI Locator
Durasoft 2 Clear
Durasoft 2 Light Eyes
Durasoft 2 Lite Tint
Durasoft 2 Opaque Colors
Durasoft 2 Optifit Light Eyes Toric
Durasoft 2 Optifit Toric
Durasoft 2 Optifit Toric MTO
Durasoft 2 Optifit Toric MTO Colors
Durasoft 3 Clear
Durasoft 3 Colors
Durasoft 3 Colorblends
Durasoft 3 Complements
Durasoft 3 Lite Tint
Durasoft 3 Opaque Colors
Durasoft 3 Optifit Toric
Durasoft 3 Optifit Toric Colors
Durasoft 3 Optifit Toric Complements
Edge III
Edge III 55
Edge III Thin
Edge III XT
Elegance Opaques
Illusions Opaques
Natural Touch (Elegance Opaques)
Optima 38 Vial
Optima Toric
Vantage
Vantage Accents
Vantage Thin
Vantage Thin Accents
Color
Right
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quantity
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2 Lenses
3 Lenses
4 Lenses
5 Lenses
6 Lenses
7 Lenses
8 Lenses
9 Lenses
10 Lenses
11 Lenses
12 Lenses
Left
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quantity
1 Lens
2 Lenses
3 Lenses
4 Lenses
5 Lenses
6 Lenses
7 Lenses
8 Lenses
9 Lenses
10 Lenses
11 Lenses
12 Lenses
Contacts Pictures and Information
Billing Information
state
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OR
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If the billing and shipping are the same, complete the above then check here
Shipping Information
state
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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Information
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Mth
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Yr
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notes:
delivery type
Send by 2 day air
Send by Regular Ground
I will pick up at Kelly Johnson BLVD
I will pick up at Union BLVD
Delivery
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