REFills / ACCOUNT UPDATES:

Email Address (to receive order confirmation)

(Required)

Customer Name *

To place a First Time Order, please click the button below to access the shopping cart.

Customer Street Address

* Orders received by 5pm EST are shipped the same day

(Required)

Free Shipping - ALL ORDERS

* Only Size Available

30 Count $14.99

60 Count $27.99

90 Count $38.99

180 Count $70.00

270 Count $105.00

360 Count $138.00

30 Count $14.99

60 Count $27.99

90 Count $38.99

180 Count $70.00

270 Count $105.00

360 Count $138.00

Choose Product *

Eye Physician (or) Office/Practice Name

New Credit Card Type

Customer Phone Number *

City

New Expiration Date

(Required)

90 Count $19.99

New Credit Card Number

Choose Type(s) *

Refill

Address Change

Credit Card Change

orders received by 5PM EST

Additional Comments or Instructions

Zip Code

1.888.442.5002

for additional information or to order call:

90 Count $14.99

State

Required fields MUST be completed (or checked) in order to process refill and/or account updates.