One Time Registration Form For Ordering Contacts Online

You must fill this form out completely before ordering your contacts. Thank-You.

Registration Form For Ordering Contacts Online

Full Name:

Address:

City:

State:

Zip Code:

Email Address:

Phone Number:

Birth Date:
WHY? (A Federal Law passed in February 2004 requires us to verify your prescription with your eye care provider. Many eye care providers use your birthday to find your prescription information.)

Prescription Information

Question 1: Are you a patient of O'Bryon Eye Associates?

Question 2: Do we have your latest prescription?

---- (If you answered yes to question 2, please skip to question 5)
---- (If you answered no to question 2, please complete questions 3, 4 & 4b:)

Question 3: The Doctors Name with your latest prescription?

Question 4: The Doctors Phone Number that has your latest prescription?

Question 4B: The Doctors Fax Number that has your latest prescription?

Question 5: Would you like to place an order, now?
If you answer yes, we will send you an invoice through email so you can pay on-line using your credit card.

Question 6: Would you like your order shipped to your home?
If you answer yes, you will be billed $4.99 per order. If you answer no, you will pick-up your order at our office.

You may now submit your order & prescription below:
Products and Prices are HERE

Contact Brand: Power R: Base Curve R: Diameter R: Colors R(if applicable): Total Boxes Ordered R: Contact Brand: Power L: Base Curve L: Diameter L: Colors L(if applicable): Total Boxes Ordered L: Please submit any important information here: YOU SHOULD RECEIVE AN EMAIL INVOICE WITHIN 48 HOURS. THANK-YOU FOR YOUR ORDER!

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Power on your prescription is a number, that starts with a + or - sign. For example, +3.50, -2.75 etc. This is to correct either your nearsightedness if it is a (-) sign or farsightedness if it is a (+) sign.

Base Curve, (BC) is a measure of the curvature of the contact lens. This makes the lens fit more comfortably on your cornea. Typically BC is in the range 8.3 to 9.0.

Diameter is a measure of the size of the lens. Typically Diameter is in the range of 14.0 to 14.5.

Sometimes, a lens is manufactured in only one base curve or diameter. Your optician may then have omitted this value on your prescription since it makes no difference anyway.

The right eye is abbreviated OD, the left OS and both eyes are OU.

Cylinder (Cyl) Is the strength of your astigmatism. If you have a number for cylinder on your prescription you should look at our Toric Lenses. Typical numbers for cylinder are -0.75, -1.00, -1.25.

Axis Is the orientation of your astigmatism on your cornea. Typical numbers for Axis are 160°, 170°, 080°.

Add power is the second power correction you need if you are wearing bifocal contact lenses. This number refers to the reading strength of the lens. Typically addpower is in the range of +1.00 to +2.50.

Colour is the colour of the contact lens and is only needed if you are buying coloured or special effect contact lenses. The colour does not affect your prescription in any way.