Order Contact Lenses Online

Name: Brampton Family Eye Care
Address: 65 Montpelier Street, Unit #E-103, Brampton, ON, L6Y 6H4, CA
Telephone: 905-497-1422

Name*
First Last
Email*
Date of Birth*
MM slash DD slash YYYY
Phone*
Do you have vision insurance?*
- Yes
- No
Provider Name (optional)
Plan ID (optional)
How many boxes of contact lenses?*
Have you had an exam within the last 12 months?*
- Yes
- No
Do you have a current prescription?*
- Yes
- No
Has your RX expired within the last 60 days?
- Yes
- No
What brand of contacts do you want to purchase?
Address where you would like lenses shipped*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Thank you for your contact lenses request. One of our staff members will be in touch with you shortly to confirm your order

Brampton Family Eye Care