Reorder Contacts

To reorder contacts at Killeen Eyecare Center, you must have a current prescription on file. Once your request has been submitted, the Killeen Eyecare Center will order your contacts. When they arrive, you will receive a phone call and/or email.

If you would like to reorder contacts from a presciption from another doctor, please call us first to transfer your prescription to the Killeen Eyecare Center.

Personal Information
First Name:*		Last Name:*
Address:		City:
State:		Zip:
Date of Birth (MM/DD/YY):	/ /	Work Phone:
Home Phone:*		Email:
Best way to contact:	Home Phone Work Phone Email	Best time to contact:	Morning Afternoon Evening

Order Information
# of Boxes for Left Eye:
# of Boxes for Right Eye:
Comments:

*Required