Cunningham Vision Care

Cunningham Vision Care 92 Chesterfield Mall Chesterfield, MO 63017 lower level next to Dillards Driving Directions Phone: 636-530-0202 Welcome to our contact lens reorder page. 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 same as in Patient Information section? Yes No
	If Not, enter Shipping Address below
	Address
	City
	State	Zip Code

Lens Prescription
Order Information	1) Enter your unique Rx code here:________________ 2) Enter the number of boxes ordered for the RIGHT EYE __________ 3) Enter the number of boxes ordered for the LEFT EYE ___________ Additional Comments:
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? Yes No
	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 636-530-0202