ORDER FORM
FIRST NAME:
FAMILY NAME:
DATE OF BIRTH:
CONTACT PHONE No:

ORDER
NUMBER OF BOXES: RIGHT EYE:
  LEFT EYE:
FOR 1-DAY ORDERS> BOX OF 30 OR 90:
COMMENTS/INSTRUCTIONS:

DELIVERY
DELIVERY IS BY EXPRESS POST AND COSTS $7.50
DELIVERY ADDRESS:
SUBURB:
POSTCODE:

WE WILL CALL/EMAIL YOU WHEN YOUR CONTACTS ARE READY FOR COLLECTION.
THIS FORM IS FOR EXISTING PATIENTS ONLY.
IF YOU DO NOT HAVE A RECORD WITH US, PLEASE EITHER:

  1. FAX YOUR PERSCRIPTION TO US: (03) 9743 1599
  2. CALL TO MAKE AN APPOINTMENT: (03) 9743 1527

CONSULTATIONS ARE BULK BILLED TO MEDICARE.