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Contact Lens Online Order Form

Clearer vision for a better life.



We accept orders from both patients and non-patients!

If you would like to place an order for contact lenses, please 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 members will call you to confirm your order.

We accept orders from both patients and non-patients. If you are not currently a patient at our office, we will need to get your prescription information from you or schedule an appointment to determine the correct lenses for your vision needs.

All fields marked with an asterisk (*) are required.

Contact Lens online order form

If you are not currently a patient, we will need to get a copy of your prescription information before we can order your lenses. Please use the online appointment form to schedule an appointment with us or give us a call with your information.

Personal Information

First Name
Last Name
(Your email address is for confirmation purposes only. It will not be shared with any third party.)

Order Details

(If you are unsure of the exact day, please use '1'; if you are unsure of the month, use 'January'.)
(**Shipping costs: If you are purchasing a six-month (4 boxes) or more supply of contact lenses, there is no shipping charge. For orders less than 6 months/4 boxes, a $6.00 shipping charge will be added to the order. See exceptions above.)


Get in Touch!

Monday - Wednesday & Friday
8:30 AM - 5:30 PM

10:00 AM - 7:00 PM


1758 Bath Road, Unit 1
Kingston, Ontario, Canada
K7M 4Y2

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Visionary Eyecare

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