Langford Eyecare Doctors of Optometry

Contact lens renewal


Fill out our new contact lens order form or call our office and contacts will be mailed free of charge to your residence.

Please note: This form is a request for the office to contact you regarding a contact lens order. No payment information is collected or processed through this form.

Your information

Title :
First name* :
Last name* :
Email* :
Telephone* :
Date of Birth* : (YYYY-MM-DD)

Order

Eyes
Quantity

Communication preferences

How would you like to be contacted?*

Message