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Account Details
Account Name:
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Account ID:
Patient Details
Patient First Name: Patient Last Name:
Practice Reference No:
Lab Reference No:

Frame & Coating Details
frame preview  

Prescription Details
Right Eye:
Sphere:
X   Axis:
Cyl:
Add:
Height:   Height Type: BOX
DOC:
PD:
Near PD:
Left Eye:
Sphere:
X   Axis:
Cyl:
Add:
Height:   Height Type: BOX
DOC:
PD: Total PD:
Near PD: Total Near PD:
  I have read the following note regarding Heights measurements:
Please note: The fitting system used at our laboratory is the box measurement system. All measurements are to be in millimetres up from the lowest point of the frame; this job will be fitted as per the box height you specify.
Prism Details
Prism: Right Eye:
Prism: Left Eye:
Special Instructions