Contact Lens Fitting Request | Little Optics

Step 1

Patient details

Full name (required)

Date of birth (required)

Phone number (required)

Email address (required)

Step 2

Have you worn contact lenses before? (required)

YesNo

Do you currently wear contact lenses? (required)

YesNo

Current lens brand or type

If applicable.

Step 3

Insurance provider

Member ID

Insurance card — front

A photo from your phone is enough. You can also bring the card to the visit.

Insurance card — back

Step 4

Preferred language

Additional notes

Submitting this request does not confirm your appointment. Our team will review your information and contact you to confirm.