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Order Contacts
Fill out this order form so we can evaluate your request. We will call you to confirm your payment method & order requirements. If you have any questions, please give us a call.
Full Name
Date of Birth (mm/dd/yyyy)
Phone (xxx-xxx-xxxx)
Email
Patient Status
Which eye(s) are you ordering contacts for

Vision Insurance Info (Optional)
Enter plan provider and your ID #
(Note: Medicaid does not cover contact lenses)
Notes
Enter Letters/Number you see:



OFFICE HOURS    
Mon
9:00 - 7:00
Tue
9:00 - 5:30
Wed
9:00 - 5:30
Thu
9:00 - 5:30
Fri
Closed
Sat
Closed
Sun
Closed
Advance Family Eyecare
5832 N Main St.
Joplin, MO 64801
(417) 623-7900
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Advance Family Eyecare 5832 N Main St. Joplin, MO 64801 Phone: 417-623-7900

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