Dr. S. Glitz and Associates

Order Contact Lenses


If you are a patient of our clinic and would like to purchase more contact lenses simply complete the following form. We will be happy to mail them to you or you can pick them up at our office. One of our staff will call you to confirm your order.

Payment is required at time of pick-up.

An order confirmation and invoice will be sent to you via email. Your contact lens prescription is valid for one year. If your prescription has expired we will contact you.

Please note that all the fields are mandatory.

Title

Full Name*:

Telephone*:

Email*:

for confirmation email only, will not be given to a third party.

Which eye(s)*:

Quantity*:

Message: