Bausch + Lomb ULTRA^® ONE DAY Trial Order Form

Use the form below to order your Bausch + Lomb ULTRA^® ONE DAY trial lenses Please Note: This is for Eye Care Professional Use Only.

Please read the Instructions for Use (IFU) for important product use and safety information.

Use: This form is intended solely for use by qualified eye care professionals to request trial lenses for professional evaluation and patient fitting purposes and are not for resale. Please read the Instructions for Use (IFU) for important product use and safety information associated with the Trial lenses.

Patient Data Prohibited: This form must not contain any patient-identifiable information. Any patient order reference must be totally anonymized. By submitting the form, you  confirm that no such data is included.

Data Privacy: Your personal data inputted on this form will be handled in accordance with our HCP Privacy Notice available at: HCP Privacy Notice.

You will be contacted for lens order details, following receipt of this email. If you do not have an account with Bausch + Lomb, following submission of this form, a Customer Service Specialist will send you an email to set up an account. This process will take 24–48 hours to complete. An account will need to be set up before trial lenses can be shipped. For trial lens delivery, please allow 3–5 working days from order.