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Adventure Vision Order Form

Glasses Reorder Form (same prescription, same frames)*  

Please complete this form if your child needs a replacement pair of glasses because of loss or breakage.  The new pair must be the same prescription and frame style and color as the lost or broken pair.  Once you submit this form you will receive an email receipt to let you know we received your order.  We will ask you to pick up your glasses at the office to ensure a proper fitting.  If your office is still closed, we will ship your glasses to your home and you should expect to receive the replacement pair of glasses as soon as possible. We appreciate your patience, as we strive to complete many orders.

*This service is only available to current patients with updated prescriptions on file and insurance that covers the full amount of the replacement.

 

Location

If you have already submitted this form you should receive an email receipt to let you know we received your order. There is no need to re-submit the form. You should expect to receive the replacement pair of glasses as soon as possible. We appreciate your patience, as we strive to complete many orders.

*This service is only available to current patients with updated prescriptions on file and insurance that covers the full amount of the replacement.
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referral program