"Where the Health of your Eyes comes first !"


Family Eyecare & Contact Lens Center, LLC. - Dr. Kirk Kvitle
727 Broadway ~ Quincy, Illinois 62301 ~ (217) 231-3937 ~ Toll Free (866) 231-3937
for current contact lens pricing, please email us at  eyecare@adams.net

Welcome to the contact lens reorder page of Dr. Kirk Kvitle. If you have a current contact lens prescription from our office, and wish to order lenses delivered to your home, office, or other location, please provide the information requested below. Your credit card will be billed at the current price for the quantity ordered.
FREE SHIPPING is often provided with the purchase of an annual supply.
Patient Information

 







  
Required fields are marked with an *
Patient Name

First  *   

Last  *   

Address *

 

 
City *

State *
       Zip Code *
Phone number
Email Address
Confirm Email Address
Shipping
Method
Is the Shipping Address the
If Not,
enter Shipping Address below

Address

 

 
City
State
       Zip Code
Lens Description (as shown on the package or prescription)

Soft lens
Gas Perm
 
Right Eye (OD)
Left Eye (OS)
Brand name
Base Curve (BC)
Diameter (Dia)
Power
(sph-cyl-axis-add)
Color
Quantity (packs)
Additional
GP Information
   
Special Request
   
Credit Card Information
 

Card Type *

Name on Card *

Expiration Date (mm/yyyy) *

Card Number *

Security Code * If on your card

Is the Credit Card Billing Address the
same as in Patient Information section?

 
If not,
enter Credit Card Billing Address below

Address *

 

 
City *
State *
       Zip Code *
 
Fraud Protection Warning:
Processing of your order may be delayed if the name and address provided for this credit card do not match the billing address of the card.

This order is subject to the expiration of product and quantity allowed by your prescription.

If you have any questions or experience any problems using this page, contact our office at (217) 231-3937 ~ Toll Free (866) 231-3937