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



OFFICE HOURS    
Mon
10:00 - 5:00
Tue
10:00 - 7:00
Wed
10:00 - 2:00
Thu
10:00 - 7:00
Fri
9:00 - 3:30
Sat
9:00 - 1:00
Sun
Closed
*Closed for lunch 1:00 - 2:00
**Alternating every other Wednesdays and Saturdays
Northbrook Family Eye Care
3117 Dundee Rd.
Northbrook, IL 60062
(847) 562-2010
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Northbrook Family Eye Care 3117 Dundee Rd. Northbrook, IL 60062 Phone: (847) 562-2010 Fax: (847) 562-2012

Northbrook Family Eye Care proudly serves Northbrook, IL and the surrounding areas of Deerfield, Wheeling, Buffalo Grove, Highland Park, Arlington Heights, Mt Prospect, Des Plaines, Glenview, Skokie, Evanston, Palatine, Prospect Heights, Schaumburg, Glencoe and Elk Grove Village.

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