Order Contacts Name* First Last Email* Daytime Phone*Supply Needed*--Please select--Supply for 3 MonthsSupply for 6 monthsSupply for 1 YearOther (please specify in comments)Pickup/Delivery Option*--Please select--Pick up from OfficeShip to me (from office)Ship from company (Can't ship to PO BOX)*If you choose to have yours delivered one of our staff members will call to confirm your order and process your payment. Shipping charges may apply*We will use your current prescription for this order *You will be contacted if your current prescription is older then 1 year old* Comments Δ