Golden Triangle Optometric Center - Caring for San Diego's Eyes for Over 40 Years

We provide this online service to our current patients. Because we have your record on file, you need not worry about what type of lenses you wear. Please select how many lenses you need for each eye.

Part 1 - Select Lens Type(s)

	Lens Type	Quantity
Right Eye
Left Eye

Part 2 - Patient Information


	Patient's Name	We need your name.
	Patient's Date of Birth
	Daytime Phone:	We need a valid phone number.
	E-mail:	We need a valid e-mail address.
	Notification Method

Part 3 - Shipping Information

Complete this section only if you have selected to have your contact lenses shipped to you. If you are picking your lenses up in our office, please skip this section.

	First and Last Name:
	Street Address:
	City:
	State:
	Zip: