Order Contacts
Fill out this order form so we can evaluate your request. We will call you to confirm your payment method & order requirements. If you have any questions, please give us a call.
Full Name
Date of Birth (mm/dd/yyyy)
Phone (xxx-xxx-xxxx)
Email
Patient Status
Which eye(s) are you ordering contacts for

Vision Insurance Info (Optional)
Enter plan provider and your ID #
(Note: Medicaid does not cover contact lenses)
Notes
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Boynton Eye Institute, P.A. 2300 S. Congress Ave. Suite 102 Boynton Beach, FL 33426 Phone: (561) 742-1944 Fax: (561) 742-0525

Boynton Eye Institute P.A. proudly serves Boynton Beach and the surrounding areas of Lake Worth, Delray Beach, Boca Raton, Greenacres, Canyon Lakes, Palm Springs, Ocean Ridge and Aberdeen.

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