Calgary Optometrist

Please fill in all required fields below and we would be happy to refill your contact lenses.

Contact lens wearers require annual health and contact lens evaluations to maintain optimal comfort, vision and health.

First name*: 
Last name*:
Date of birth* (YYYY/MM/DD): / /
Day time telephone*: 
(for confirmation email only, will not be given to a third party)
Type of lenses required*:  Name of product:  
  Right Eye Left Eye
  Quantity: 1 year 6 months Refill my last order
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