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1-Day Acuvue Moist (30 lenses)
for Astigmatism
100% free shipping
with every Sightbox delivery
Patient & Delivery Info
PATIENT
PATIENT
RIGHT EYE (OD)
RIGHT EYE (OD)
LEFT EYE (OS)
LEFT EYE (OS)
VERIFICATION
VERIFICATION
VISION INSURANCE
VISION INSURANCE
DELIVERY
DELIVERY
PATIENT
PATIENT
RIGHT EYE(OD)
RIGHT EYE(OD)
LEFT EYE(OS)
LEFT EYE(OS)
VERIFY
VERIFY
INSURANCE
INSURANCE
DELIVERY
DELIVERY
Who will be wearing these contact lenses?

OD stands for 'Oculus Dexter'

What prescription for your right eye (OD)?
Select a prescription for your right eye (OD).
1-Day
1-Day Acuvue   - 30pk
1-Day Acuvue Define Natural Shimmer - 30pk
1-Day Acuvue Define Accent Style - 30pk
1-Day Acuvue Define Natural Shine - 30pk
1-Day Acuvue Define Natural Sparkle - 30pk
1-Day Acuvue Define Vivid Style - 30pk
1-Day Acuvue Moist Multifocal - 30pk
1-Day Acuvue Moist   - 30pk
1-Day Acuvue Moist for Astigmatism - 30pk
1-Day Acuvue Oasys   - 90pk
1-Day Acuvue Oasys for Astigmatism - 30pk
1-Day Acuvue TruEye   - 90pk
Biotrue ONEday for Presbyopia - 30pk
Biotrue ONEday   - 30pk
Biotrue ONEday for Astigmatism - 30pk
Clariti 1 Day   - 90pk
Clariti 1 Day Multifocal - 30pk
Clariti 1 Day Toric - 30pk
ClearSight 1 Day   - 30pk
ClearSight 1 Day Toric - 30pk
Dailies Aqua Comfort Plus   - 30pk
Dailies Aqua Comfort Plus Toric - 30pk
Dailies Aqua Comfort Plus Multifocal - 30pk
Dailies Total 1   - 30pk
Dailies Total 1 Multifocal - 30pk
Focus DAILIES   - 30pk
Focus DAILIES Toric - 30pk
FreshLook ONE-DAY   - 10pk
MyDay   - 90pk
Proclear 1 Day   - 30pk
Proclear 1-Day Multifocal - 30pk
SofLens Daily for Astigmatism - 30pk
SofLens Daily   - 90pk
2-Week
Acuvue 2   - 6pk
Acuvue Oasys Multifocal - 6pk
Acuvue Oasys Toric - 6pk
Acuvue Oasys   - 12pk
Avaira Toric - 6pk
Avaira   - 6pk
Avaira Vitality   - 6pk
Avaira Vitality Toric - 6pk
Biomedics Toric - 6pk
Biomedics 55 Premier   - 6pk
Biomedics XC   - 6pk
Extreme H2O 54%   - 6pk
Extreme H2O 54% LC Toric - 6pk
Extreme H2O 54% MC Toric - 6pk
Extreme H2O 59% Thin   - 6pk
Extreme H2O 59% Xtra   - 6pk
Extreme H2O Weekly   - 12pk
Freshlook Colorblends   - 6pk
FreshLook Dimensions   - 6pk
Freshlook Handling Tint   - 6pk
Soflens Multifocal - 6pk
Soflens 38   - 6pk
Soflens 66 Toric - 6pk
Vertex   - 6pk
Vertex Toric - 6pk
Vertex XR Toric - 6pk
Monthly
Acuvue Vita   - 6pk
Air Optix Toric - 6pk
Air Optix Aqua Multifocal - 6pk
Air Optix Aqua   - 6pk
Air Optix Colors   - 6pk
Air Optix HydraGlyde   - 6pk
Air Optix Night-Day Aqua   - 6pk
Biofinity   - 6pk
Biofinity Multifocal - 6pk
Biofinity Toric - 6pk
Biofinity Energys   - 6pk
Biofinity XR Toric - 6pk
Biofinity XR   - 6pk
Extreme H2O Monthly   - 6pk
Frequency 55   - 6pk
Frequency 55 Toric - 6pk
Frequency 55 Aspheric   - 6pk
Frequency 55 XR Toric - 6pk
Proclear Toric - 6pk
Proclear Multifocal - 6pk
Proclear   - 6pk
Proclear XR Toric - 6pk
Purevision Toric - 6pk
Purevision Multifocal - 6pk
Purevision   - 6pk
Purevision 2 Multifocal - 6pk
Purevision 2 Toric - 6pk
PureVision 2 HD   - 6pk
Ultra for Astigmatism - 6pk
Ultra for Presbyopia - 6pk
Ultra   - 6pk
Quarterly
Preference Toric - 4pk
Preference DW/FW   - 4pk
Preference Standard   - 4pk
Preference XR Toric - 4pk
Weekly
Acuvue Oasys 1-Week Overnight   - 54pk
CLICK TO CHANGE LENS
1-Day Acuvue Moist (30 lenses) for Astigmatism Contact Lenses
1-Day Acuvue Moist (30 lenses) for Astigmatism
Power (PWR/D)
Base curve (BC)
Diameter (DIA)
Cylinder (CYL)
Axis (AX)

OS stands for 'Oculus Sinister'

What prescription for your left eye (OS)?
Select a prescription for your left eye (OS).
1-Day
1-Day Acuvue   - 30pk
1-Day Acuvue Define Natural Shimmer - 30pk
1-Day Acuvue Define Accent Style - 30pk
1-Day Acuvue Define Natural Shine - 30pk
1-Day Acuvue Define Natural Sparkle - 30pk
1-Day Acuvue Define Vivid Style - 30pk
1-Day Acuvue Moist Multifocal - 30pk
1-Day Acuvue Moist   - 30pk
1-Day Acuvue Moist for Astigmatism - 30pk
1-Day Acuvue Oasys   - 90pk
1-Day Acuvue Oasys for Astigmatism - 30pk
1-Day Acuvue TruEye   - 90pk
Biotrue ONEday for Presbyopia - 30pk
Biotrue ONEday   - 30pk
Biotrue ONEday for Astigmatism - 30pk
Clariti 1 Day   - 90pk
Clariti 1 Day Multifocal - 30pk
Clariti 1 Day Toric - 30pk
ClearSight 1 Day   - 30pk
ClearSight 1 Day Toric - 30pk
Dailies Aqua Comfort Plus   - 30pk
Dailies Aqua Comfort Plus Toric - 30pk
Dailies Aqua Comfort Plus Multifocal - 30pk
Dailies Total 1   - 30pk
Dailies Total 1 Multifocal - 30pk
Focus DAILIES   - 30pk
Focus DAILIES Toric - 30pk
FreshLook ONE-DAY   - 10pk
MyDay   - 90pk
Proclear 1 Day   - 30pk
Proclear 1-Day Multifocal - 30pk
SofLens Daily for Astigmatism - 30pk
SofLens Daily   - 90pk
2-Week
Acuvue 2   - 6pk
Acuvue Oasys Multifocal - 6pk
Acuvue Oasys Toric - 6pk
Acuvue Oasys   - 12pk
Avaira Toric - 6pk
Avaira   - 6pk
Avaira Vitality   - 6pk
Avaira Vitality Toric - 6pk
Biomedics Toric - 6pk
Biomedics 55 Premier   - 6pk
Biomedics XC   - 6pk
Extreme H2O 54%   - 6pk
Extreme H2O 54% LC Toric - 6pk
Extreme H2O 54% MC Toric - 6pk
Extreme H2O 59% Thin   - 6pk
Extreme H2O 59% Xtra   - 6pk
Extreme H2O Weekly   - 12pk
Freshlook Colorblends   - 6pk
FreshLook Dimensions   - 6pk
Freshlook Handling Tint   - 6pk
Soflens Multifocal - 6pk
Soflens 38   - 6pk
Soflens 66 Toric - 6pk
Vertex   - 6pk
Vertex Toric - 6pk
Vertex XR Toric - 6pk
Monthly
Acuvue Vita   - 6pk
Air Optix Toric - 6pk
Air Optix Aqua Multifocal - 6pk
Air Optix Aqua   - 6pk
Air Optix Colors   - 6pk
Air Optix HydraGlyde   - 6pk
Air Optix Night-Day Aqua   - 6pk
Biofinity   - 6pk
Biofinity Multifocal - 6pk
Biofinity Toric - 6pk
Biofinity Energys   - 6pk
Biofinity XR Toric - 6pk
Biofinity XR   - 6pk
Extreme H2O Monthly   - 6pk
Frequency 55   - 6pk
Frequency 55 Toric - 6pk
Frequency 55 Aspheric   - 6pk
Frequency 55 XR Toric - 6pk
Proclear Toric - 6pk
Proclear Multifocal - 6pk
Proclear   - 6pk
Proclear XR Toric - 6pk
Purevision Toric - 6pk
Purevision Multifocal - 6pk
Purevision   - 6pk
Purevision 2 Multifocal - 6pk
Purevision 2 Toric - 6pk
PureVision 2 HD   - 6pk
Ultra for Astigmatism - 6pk
Ultra for Presbyopia - 6pk
Ultra   - 6pk
Quarterly
Preference Toric - 4pk
Preference DW/FW   - 4pk
Preference Standard   - 4pk
Preference XR Toric - 4pk
Weekly
Acuvue Oasys 1-Week Overnight   - 54pk
CLICK TO CHANGE LENS
1-Day Acuvue Moist (30 lenses) for Astigmatism Contact Lenses
1-Day Acuvue Moist (30 lenses) for Astigmatism
Power (PWR/D)
Base curve (BC)
Diameter (DIA)
Cylinder (CYL)
Axis (AX)
We are required by law to verify your contact lens prescription.
Eye care contact lens prescription rx
Upload a photo or scanned copy of your valid prescription
  - OR -  
Eye care contact lens provider name
Select your doctors name from a list of eye care providers
Upload a copy of members prescription?
Prescription has been saved!
Find your eye doctor?
Don't have a copy of your prescription? That's okay.
Type a nearby zipcode and select your doctor from the list that appears.
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    Policy Information
    Patient's relationship to policy subscriber:
    Policyholder/Subscriber
    Standard Insurance Authorization Statement:
    By signing below, I acknowlege that I hereby understand that without prior authorization from my insurance carrier for services rendered, I may be denied reimbursement for submitted vision care services for which I am not eligible under my plan. I hereby authorize any insurance company, organization, employer, opthalmologist, optometrist, and optician to release my vision Insurance Plan any and all information necessary to process this claim. I certify that the information furnished in support of this claim is true and correct.

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    What Contacts Do You Wear?

    Daily Disposable Lenses

    I put in a fresh pair of lenses every day.

    Extended Wear Disposable Lenses

    I change my lenses every 2-4 weeks.
    Sightbox is designed to deliver contacts to daily disposable wearers exclusively.
    Okay. Got it.

    Other

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    Sightbox Confirmation

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    Cheers!

    Your Sightbox Happiness Team
    Sightbox Confirmation

    Account Created

    Thank you for creating a membership profile and updating your billing information. Once our team has confirmed your prescription with your eye doctor, we will organize your first Sightbox delivery via overnight shipping.

     

    Welcome to the Sightbox family.

    Your Sightbox Happiness Team
    Sightbox Confirmation

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    Sightbox Payment Confirmation

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    PLEASE CONFIRM

    In order to use a current prescription, you will need to upload a photo of it.

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