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Welcome to the Bausch & Lomb Contact Lens 90 Day Patient Satisfaction Guarantee web site. Please keep copies of this form for your records. Should you have questions about this form, call 1-866-719-1771

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Enter your Personal Information *First Name*Last Name*Address*City*State*ZipEmailConfirm EmailI agree that Bausch & Lomb may contact me via email to provide information on eye care products that may be of interest to me.

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*Why are you returning your Bausch & Lomb contact lenses?Vision is not as good as other contact lens brandsComfort is not as good as other contact lens brandsThe lens is more difficult to handle than other contact lens brandsPrice is higher than other contact lens brandsOther

What brand of contact lenses if any, were you wearing before you purchased Bausch & Lomb contact lenses?

What will be your chosen form of vision correction?I will return to my previous contact lens brandI will try a new brand of contact lensesI will no longer wear contact lensesLasik surgeryEye glasses only

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