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Complete the information below and a member of our team will process your contact lens order and contact you regarding rebate eligibility if applicable. If you wish to use vision plan benefits to pay for your contacts, use this option.
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Are you a new or existing patient with SeaView Eyecare?

A valid contact lens evaluation with an updated prescription within the last 365 days is required for all orders placed, if you are a new patient to us, someone from our staff will be in contact with you to verify your prescription upon receiving your order form.

Quantity

(in the comment section tell us how many boxes you would like to order for each eye)

Comments / Questions:

Would you like us to check to see if you are eligible through your vision insurance for this order?

Would you like your contacts shipped to you or would you like to pick up in office? Additional charges may apply if shipped to you.​​​​​​​

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