Contact Lenses Order Form

This form is for established McFarland Clinic Eye Department contact lens wearers.

Where would you like your contact lenses delivered

Patient information

First name:
Last name:
Date of birth:
Work number:
Home number:
email:

Are you a McFarland Clinic employee/dependent family member?
Are you a Mary Greeley employee/dependent family member?

Doctor and contact lens information

Type of contact: Doctor:

Right eye: Single lens or Left eye: Single lens or

Color if applicable:

Pick up or mail

Pick-up
Mail

Mail - Payment by credit card prior to shipping. We will contact you when your lenses arrive to obtain credit card information.

Address:

City: State: Zip:

Additional comments:

You will be sent a confirmation from the Eye Center within 24 hours. Your lenses will be available for pick-up in one week unless otherwise notified. Payment in full due at time of pick-up.

Thank you!

Click Here for Eye Center Locations

McFarland Clinic PC is central Iowa's largest physician-owned multi-specialty clinic. The McFarland Clinic PC network of health care providers serves residents
in 11 Iowa communities with an additional 12 communities served by physician outreach clinics. We strive to be the trusted choice for coordinated healthcare delivered by caring professionals dedicated to individual well-being.
For more information, please contact (515) 239-4400.