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JASPER AVE ORDER FORM

Get your contact lense refills here

Order Contacts from Jasper Ave Form

Online orders are accepted only from existing patients to refill existing prescriptions. If you are a new patient and wish to order contact lenses, please contact any of our eye centre locations and one of our representatives will able to help you.


If you would like to place an order through our downtown location, please fill out the below eform.

Guy wearing contact lenses

First Name*

Last Name *

Mailing Address *

City

Province*

Postal Code*

Email*

Daytime Phone*

Cell

Date of Birth

Quantity*

Delivery Information *

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