Accepting New Patients
(604) 913-0135
1516 Marine Drive
West Vancouver, BC
V7V 1H8
(604) 984-2020
61 Lonsdale Avenue
North Vancouver
V7M2E5
info@hollyburneyeclinic.com



Contact Lens Reorder Form

Note: You must fill in all the required fields

First Name: 

Last Name: 

Email Address:

Daytime phone number(cellphone preferred):

Pick-up Options:      OR     
Address:
Province/State:
City:
Postal/Zip:  
Country:

We will use your current prescription for the order.
You will be contacted if your current prescription is no longer valid.


Quantity of boxes of contact lenses:  

Additional Comments: (Optional)


Human test:

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