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Name

Order Number

Note

Sphere (OD) Right Eye

Cyl (OD) Right Eye

Axis (OD) Right Eye

Add Power (OD) Right Eye

Sphere (OS) Left Eye

Cyl (OS) Left Eye

Axis (OS) Left Eye

Add Power (OS) Left Eye

PD (OD) Right Eye

PD (OS) Left Eye

Optional Upload (You still need to enter your PD)

If you have one PD number, divide it by two and enter that number for each eye. Need to get your PD? Click Here

For Example: Total PD is 61.5
61.5 / 2 = 30.75 (Enter 30.75 for each eye)