Order Contact Lenses

Please note that we do not provide a delivery service for contact lenses. We will notify you when your contact lenses are ready for collection.

Contact lens orders are only available for patients who have had an eye examination in the last year.

    Personal Details

    1. First Name

    2. Surname

    3. Email

    4. Cell

    5. ID number or date of birth

    Lens Details

    1. Brand of lenses

    2. Script R

    3. Script L

    4. Claim from medical aid?

    Medical Aid Details

    1. Medical Aid Name

    2. Medical Aid Number

    3. Main Member

    4. Main Member ID

    5. Dependent Name

    6. Dependent ID

    Collection

    1. Additional Comments