(416) 466-6670
318 Broadview Avenue
Toronto, ON
M4M 2G9
broadview.optometrist@rogers.com*
We Moved at our Eaton Centre Location!
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Our Doctors
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Eyewear
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Our Services
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Two Pairs of Glasses for $179
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Contact Lens Reorder Form
Note: You must fill in all the required fields
First Name:
Last Name:
Email Address:
Daytime phone number(cellphone preferred):
Pick-up Options:
On-site pick-up
OR
Delivery
Address:
Province/State:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
City:
Postal/Zip:
Country:
Canada
United States
We will use your current prescription for the order.
You will be contacted if your current prescription is no longer valid.
Quantity of boxes of contact lenses:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Additional Comments: (Optional)
Human test:
Enter Code Here:
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