Contact Lens Order Form
This contact lens order form is designed for EXISTING contact lens wearers who are customers at Milford Optometrists. 

If you are a customer of ours but do not currently wear contact lenses, please call us on 09 489 4797 or email info@milfordoptometrists.co.nz to schedule an appointment to see which contact lenses are right for you.

If you are not a customer of ours yet, welcome! Please call us on 09 4894797 or email info@milfordoptometrists.co.nz to book an appointment with us. 
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First Name *
Last Name *
Date of Birth *
We use your date of birth to ensure that we have found the right person in our system, so that we can order the correct contact lenses for you. 
Contact number or email address *
This supplied contact will be the way we will contact you to let you know your lenses have been ordered and to let you know when your lenses are ready to be collected. 
How many months' supply would you like to order? *
Use the 'Other' box if you would like to order less than a month's supply, or a different amount of lenses.
Would you like to order contacts for your... *
Would you like to pick up your lenses or have them shipped directly to you? *
Please note: if you choose to have your contact lenses shipped directly to you, you will need to cover an additional courier fee. 
Are there any other details we should know?
E.g. If you use multiple types of contact lenses (e.g. dailies and monthlies), or know the brand name of the contact lenses you use/prefer please specify which one you would like to order. 
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