Mediflex® Aquafinity XR

Mediflex

Select Quantity

Right eye (OD)

1 box
Left eye (OS)

1 box

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How will you provide your contact lens prescription?

Existing Patient

Enter your details so we can retrieve your prescription
Enter Prescription

Add new prescription,
this will be saved for future use
Upload Prescription

Upload or take a photo of your paper prescription
Send Later

Email us a copy of your prescription after placing your order

Change Prescription Method

Existing patient?

Enter your details so we can retreive your contact lens prescription

Who is the
prescription for? *

First Name*

Last Name*

Date of Birth*

Send your contact lens prescription later

You can send us your prescription later by email to office@drbrucecoward.com
Upon completing your order, you will receive a reminder.
Alternatively, you can enter your prescription now.

Who is the
prescription for? *

First Name*

Last Name*

Upload your contact lens prescription

Upload
Prescription *

Take a photo of your paper prescription

Upload Prescription Allowed Types (PDF, PNG, JPEG, JPG)

Prescription uploaded Details will be added to your order after checkout.

Who is the
prescription for? *

First Name*

Last Name*

Enter your contact lens prescription

Right Eye (OD)
Sphere Base Curve Diameter
Left Eye (OS)
Sphere Base Curve Diameter

Who is the
prescription for? *

First Name*

Last Name*

Date of birth*

We need to verify your prescription

Contact lenses are medical devices and require a prescription.

Verification
method *

Upload your prescription A contact lens prescription valid
within the expiry period

Verify with my doctor Provide your doctor contact details and your date of birth.

* Please select a verification method.

Doctor Details *

Enter Name/Eyecare Provider

Doctor/Eyecare Provider* * This field is required
Doctor Phone* * This field is required
Doctor Email * Valid email address is required
Doctor Fax * This field is required

I authorize Dr. Bruce Coward & Associates to contact my doctor and obtain prescription information*

Need help? Contact us

Back

Quantity discounts available:

Mediflex® Aquafinity XR

Mediflex

$56.00
per box

(6 Lenses)

How will you provide your contact lens prescription?

Existing Patient

Enter Prescription

Upload Prescription

Send Later

Existing patient?

Who is the
prescription for? *

Send your contact lens prescription later

Who is the
prescription for? *

Upload your contact lens prescription

Upload
Prescription *

Prescription uploaded Details will be added to your order after checkout.

Who is the
prescription for? *

Enter your contact lens prescription

Who is the
prescription for? *

We need to verify your prescription

Verification
method *

Doctor Details *

Enter Name/Eyecare Provider

Mediflex® Aquafinity XR

Delivery & Returns

Delivery

Returns and exchanges

Back

Quantity discounts available:

Mediflex® Aquafinity XR

Mediflex

$56.00 per box

(6 Lenses)

How will you provide your contact lens prescription?

Existing Patient

Enter Prescription

Upload Prescription

Send Later

Existing patient?

Who is the prescription for? *

Send your contact lens prescription later

Who is the prescription for? *

Upload your contact lens prescription

Upload Prescription *

Prescription uploaded Details will be added to your order after checkout.

Who is the prescription for? *

Enter your contact lens prescription

Who is the prescription for? *

We need to verify your prescription

Verification method *

Doctor Details *

Enter Name/Eyecare Provider

Mediflex® Aquafinity XR

Delivery & Returns

Delivery

Returns and exchanges

$56.00
per box

Who is the
prescription for? *

Who is the
prescription for? *

Upload
Prescription *

Who is the
prescription for? *

Who is the
prescription for? *

Verification
method *