ORDERS

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
CONTACT LENSES EXPRESS POSTED FOR $5.00
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: FAX YOUR PERSCRIPTION TO US: (03) 9682 8898 CALL TO MAKE AN APPOINTMENT: (03) 9682 8899 CONSULTATIONS ARE BULK BILLED TO MEDICARE.

ORDER FORM