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Order Contact Lenses
Please note that we do not provide a delivery service for contact lenses. We will notify you when your contact lenses are ready for collection.
Contact lens orders are only available for patients who have had an eye examination in the last year.
Personal Details
First Name
Surname
Email
*
Cell
ID number or date of birth
Lens Details
Brand of lenses
Script R
Script L
Claim from medical aid?
Yes
No
Medical Aid Details
Medical Aid Name
Medical Aid Number
Main Member
Main Member ID
Dependent Name
Dependent ID
Collection
Additional Comments
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