Contact Lens Re-Order

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Evening Phone:
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DOB *:
Referring Physician *:
Referring Physician Phone *:

 

Order Information

*Fees Include Tax

Right Lens B.C. *:
Left Lens B.C. *:
Right Lens DIA *:
Left Lens DIA *:
Right Lens Quantity *:
Left Lens Quantity*:
Sphere Right Lens Power *:
Sphere Left Lens Power *:
Cylinder Right Lens Power:
Cylinder Left Lens Power:
Axis Right Lens Power:
Axis Left Lens Power:

 

Payment and Billing Information

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Shipping Information

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Pick up at the Nampa Office
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*Shipping cost for all contacts is $7.50*

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Hours & Appointments

To help provide timely service to our patients, we prefer to schedule all visits. If you are unable to keep an appointment, we ask that you kindly provide us with at least 48 hours' notice. This courtesy on your part will make it possible to give your appointment to another patient.

Our office is open: Physicians at this location: Peter Jensen MD Johanna Jensen MD Hours: Mon - Fri 8:00 am - 5:00 pm