Three Rivers Eye Care is happy to place your order for contact lenses.  Please place your order with this form.  We will contact you by phone to confirm your order.  Thank you!

 

Order Contact Lenses
First name  *
Last name  *
Home Phone #  *
Email  *
Address  *
City  *
State  *
Zip Code  *
# Boxes for Right Eye
# Boxes for Left Eye
Comments/Instructions
* Required fields

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