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RX Verification

Please visit https://www.primalcontactlenses.com/ for all additional information.

Verification

First name*

Last name*

Phone*

Email*

Address*

Prescriber Name*

Office / Clinic Name*

Office / Clinic Phone*

Office / Clinic Email

Issue Date*

Expiration Date*

Lens Brand*

Power (Sphere)*

Base Curve*

Diameter*

Add Cylinder / Prism (if applicable)

Any notes provided by prescriber

By continuing, you authorize us to contact your prescriber to verify your prescription. We cannot fulfill contact lens orders without a valid prescription.

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321 W 19th Street, Suite A
Houston, Texas 77008

Monday: Closed
Tuesday-Thursday: 10am-7pm
Friday-Saturday: 10am-9pm
Sunday: 10am-6pm

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RX VERIFICATION

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