Homosassa Eye Clinic & Beverly Hills Eye Clinic

Welcome to Homasassa and Beverly Hills Eye Clinic

Online Order Form

To order contact lenses from Homosassa Eye Clinic please complete the following information and click the “Submit Order” button below.

Click here for the Credit Card Consent Form

Patients Name (First, Last, Initial)
Patient's Birthdate
Daytime Phone Number
Evening Phone Number
Mailing Address
Lens Order Quantity
How would You like to be contacted when order is ready?
Patients Email
Comments:

*If not an existing patient, you may fax your contact lens prescription to Homosassa Eye Clinic at 352-628-6377 or to Beverly Hills Eye Clinic at 352-527-1358.

If you would like your lenses mailed (instead of picking them up at our office), there is a mailing fee of $5 and we will have to get payment over the phone in order to mail the order. If you would like to pay by credit card, you may fill out a Credit Card Consent Form that we can keep on file for you.