Federal Hill Eye Care

Order Products Form

After filling out the form below, please hit the Submit button at the bottom of the page. We will review your needs and order your requested products within 24 hours. If we have any questions regarding your order, we will contact you by phone immediately. As an additional service, you can have your order shipped to your home or office.

Name:

Address:

City: State: Zip:

Phone: Email:

To order products online, you need to complete the following steps:

1. Type or Brand of contact lenses:
Right Eye Left Eye

2. Fill in your prescription for the:
Right Eye Left Eye

3. Fill in your base curve (B.C.) for the:
Right Eye Left Eye

4. Quantity of boxes:
Right Eye Left Eye

5. Write any additional questions, concerns or pertinent information about the products you are ordering here: