Online Contact Order Form - Beamsville Optometrist | Dr. Wylie Tan & Dr. Timothy Hennig

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Mon - Thus 9:00AM - 5:30PM; Fri 9:00AM - 2PMSaturday and Sunday - CLOSEDTel: (905) 563-5333 Fax: (905) 563-7397info@youreyesareworthit.ca4266 Queen St.Beamsville, ON L0R 1B0

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ORDER YOUR CONTACT ONLINE TODAY

Order contact easily

Send us your order information and then we will call you to confirm and ship it out for you.

Are you a current patient? *

You can send prescription information to info@youreyesareworthit.ca

Name *

First

Last

Date of Birth

Email *

Phone *

Preferred method of contact *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Order Details

When was your last eye exam? (Estimated data is fine) *

Type of lenses required? *

Acuvue Oasys 1-Day 90 pack
Acuvue Oasys 1-Day Astigmatism 90 pack
Acuvue 1-Day Moist 90 pack
Acuvue Oasys for Astigmatism
Acuvue Oasys for Presbyopia
Dailies Total 1 90 pack
Air Optix
Air Optix for Astigmatism
Air Optix Multifocal
Other

Please describe

Eyes *

Right Eye
Left Eye

Quantity

Or, number of boxes

Preferred delivery: *

Comment or Message

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(905) 563-5333 info@youreyesareworthit.ca Monday – Friday 9AM – 5:30PM Saturday and Sunday – CLOSED 4266 Queen St.Beamsville, ON L0R 1B0

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