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Account Name
Account Number
Dispenser's Name
$customer:acct_name$
$customer:acct_no$
$customer:name$
Patient Name Patient Address

Last Name First
Check if
mail to patient.
Sphere Cylinder Axis Prism Prism Direction Base Curve Dec.

Add Height Opt. Cntr. Location Inset Total Inset & Decentration
PD Mono Dist. Mono Near
Distance R: R:
Near L: L:

Material

Polarized


(Other)


Lens Thickness
Standard
Groove
Industrial
Other
Please Specify:
OD.
OS.
Indicate Lens Style Other...
OD.
OS.
Tints Tint Type

Plastic Tint
(Color: )

Glass Color
(Color: )
Other: Tint %

Photochromic
Plastic Type

Special Tinting Instructions:

Lens Measurement

Frame Information

Frame Material

Job Type

A: Name/Style: Metal Uncut
B: Manufacturer: Plastic Lenses Only
ED: Eye Size: Groove To Come
DBL: Bridge Size: Drill Supply Frame
C Size: Temple Size: 1/2 Eye Pattern To Follow
Style/Mfr:
Color:
Edge Glass Tempering Coatings
Polish Edges Heat Treat Scratch Resistant
Roll & Polish Chemical AR Coating AR1
Roll Only UV Treatment
Facet Mirror
Engrave Temple Color
Engrave Lens Duralux
Engraving:

Frame and Lens Packages
Fisher Price

Special Instructions


 

 

SOLAOne is available in Plastic, Polycarbonate, Transition Plastic, Transition Polycarbonate, High Index 1.60, High Index 1.67

 

New Kodak InstaShades Lenses Now Available from ROL

 

PolarShades Now Available in Kodak Precise

 


 
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