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Interested in learning more about our services? Just complete the form below.

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RESIDENT ORDER FORM

Complete this page if you have qualified for our eyeglass program or if you prefer to self pay for an eye exam at one of our facilities. Once submitted, you will be able to checkout using a debit or credit card.

RESIDENT INFORMATION

SELECT OPTION

Private Pay Eye Exam - $60

Bifocal lenses with Black frame - $15

Bifocal lenses with Clear frame - $15

Reading only with Black frame - $15

Reading only with Clear frame - $15

Distance only with Black frame - $15

Distance only with Clear frame - $15

EYEGLASS POLICY
If you select to order eyeglasses, please note that deliveries take up to 30 days to reach the nursing home. Once payment is received, we will process the order using the resident's prescription from their most recent exam. We exclusively use plastic frames and do not offer no-line bifocals or transition lenses.

PRIVATE-PAY EXAM POLICY
If you select to receive a self-pay exam without using insurance, we will add you to our next monthly visit. Exams include an eyeglass prescription, if applicable.

I agree to these policies

Thanks for your order!

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