EXAM & LENS FITTING
COLOR FASHION LENS
LENS INFORMATION REQUEST
THANK YOU FOR SHOPPING WITH US!!!
Please arrange to have contact lens RX fax in or mail in prior to ordering. Please FAX RX to 415-772-1904 or mail RX to Contact Lens Expo: 896 Stockton St, SF, CA 94108 or email ContactLensExpo@aol.com.
Filed with a * asterisk mark is a required field.
Right Eye OD
Left Eye OS
Reading ADD RX
Color (for Color Lens)
FOR RGP LENS PLEASE SPECIFY
For combination Color Lens or other special request, please type in the following box:
Is youe contact lens prescription valid?
Do you need new exam and / or lens fitting?
Have you been fitted for contact lens you request above?
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