For the free replacement of defective or torn contact lenses purchased from Associates in Eyecare, please submit the form below. Please note that to be eligible for free replacements you must have purchased a year’s supply.

*(denotes required field)

Name:*

E-Mail Address:*

Phone Number:

Please Select Which Office You Purchased an Annual Supply From:

Bristow
Stone Ridge
Oakton

Please Select Which Eye the Replacement is For:

Left
Right

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