This form is for patients currently under care at The Children’s Hospital Westmead Eye Clinic. Please don't use this form if your child is having problems with their contact lenses. Call the Eye Clinic on (02) 9845 2270. 1 Start 2 Complete What's your name? * Please provide your first name and surname. What's your child's name? * Please include first name and surname. What's your email address? * What's the best number to call you on? * Has your script changed since your last order? * Yes No When was the last appointment? * Less than 6 months ago 6-12 months ago Longer than 12 months ago (we might contact you to arrange a clinic appointment) Please tell us why you need new contact lens? * Lost Spare Replenishment Left eye requirements Left eyeTint colourQuantity Left eye Left Tint colour SelectClearBlue Quantity Select1234 Right eye requirements Right eyeTint colourQuantity Right eye Right Tint colour SelectClearBlue Quantity Select1234 Collection * Please tell us how you would like to receive the contact lens when they are ready. Please post them We will collect them at our next appointment Please call me and we will arrange a time to collect them from the hospital. Once the order is ready, we will call you to find out your preferred postal address.
