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CONTACT LENS RE-ORDER FORM

If you are a patient of Romin Optical, please fill out the form below to re-order your contact lenses.

  If you are not a patient at Romin Optical or have not had a contact lens fitting, call us at (519) 620-1991 or schedule a contact lens fitting here (Schedule a Contact Lens Fitting).

CONTACT DETAILS:
CONTACT BY:
RE-ORDER DETAILS:
RE-ORDER QUANTITY:
DELIVERY OPTIONS:
SHIPPING DETAILS:
We will use your current prescription for the order. You will be contacted if your current prescription is no longer valid.

ADDITIONAL COMMENTS:
We will contact you with a quote for the contact lenses prior to placing the order. Payment is due upon pick-up or via E-transfer.

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