Contact Lens Order Form

Please complete this form and we will contact you within two business days to confirm your order. Fields with an * are mandatory.

Location*
We now have 2 locations to serve you better. Our main clinic is still located at 265B Concession Street. Our satellite clinic is located in the east end of Kingston at 677 Innovation Drive, Unit 5, just off Highway 15.
Number of months required*
Doctor*
Name
First Last
Phone
Email
Date of Birth*
MM slash DD slash YYYY
Delivery?*
- Yes
- No
Some distributors offer shipping of contact lenses directly to patients - if you responded "Yes" above please leave your daytime address in the Comments section below (contact lenses have to be signed for when received by mail as they are medical devices).
Comments
Leave any extra details if necessary.

St Lawrence Optometry Downtown