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ORDER ONLINE

PRACTICE NAME

ORDER NO.

DATE

TEL NO.

PATIENT DETAILS

LENS TYPE

Single Vision Distance Single Vision Readers Bifocal Multifocal

INDEX

1.74 1.67 1.6 1.56 1.5

COATINGS

Blue block AR Super AR HMC UV Hard Coat Uncoated

MULTIFOCAL DESIGN

Personalized (Platinum) Lifestyle Digital (Gold) Premium Digital (Silver) Conventional (Bronze) Other

SERVICES

Standard Fitting Nylon Fitting Rimless Fitting Uncuts

MATERIALS

Polarized Transition Sunshade / Veyzer Clear

TINT

Fixed Gradient

COLOUR

R - SPHERE

R - CYL

R - AXIS

ADDITION

L - SPHERE

L - CYL

L - AXIS

ADDITION

R - PD DISTANCE

R - PD NEAR

R - SEG HEIGHT

L - PD DISTANCE

L - PD NEAR

L - SEG HEIGHT

FRAME DETAILS

FRAME SIZE - Horizontal

FRAME SIZE - Vertical

FRAME SIZE - Bridge

FRAME - Diameter

OTHER INSTRUCTIONS

PLEASE CONFIRM

I confirm that I have checked all details on the order and understand that the order cannot be changed once in production

Did you get an error message when submitting the above form? If so, please press the”PLACE ORDER” button again. If the problem still persists please email:LENSCO SUPPORT

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Cedo Kids – 8133
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Cedo Kids – 8132
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ORDER ONLINE

Cedo Kids – 8133

Cedo Kids – 8132