Medical Prescription reorder
Ordering eye vitamin supplements
Making an appointment
Attend a FREE Seminar
Patient Privacy
Name  (required)
Phone
Email  (required)
Area of Interest  (required)
Message


Secure Order Form
Contact Reorder form:
Great service and great prices, that's why Grand Rapids Ophthalmology is the leader in contact lenses! As a convenience for our contact lens patients, you can now reorder your contact lens refill directly from our website. Ordering is safe and all information is securely transmitted for your protection and privacy. To order your contacts, follow these simple steps:

  1. Fill out the contact lens form.
  2. Next, one of our contact lens professionals will call you to confirm and review your order.
  3. Following the call you will receive an email outlining the price and type of contact lenses you have ordered.
  4. Upon your approval, we will ship your contacts directly to you, whenever your want them delivered!

Please complete the entire form below:

Name:
Address:
City: State: Zip:
E-mail:
Phone: Phone2:  
Specify: Boxes:  

Billing Information
Name On Card:
Credit Card Type:
Credit Card Number:   (no dashes)
Expiration Date:    (mmyy)
Comments: