Rx Lens Order Form - GT EYEWEAR
Please fill in all required fields (*)
Patient Information *
Customer Email
Customer
Patient Reference
Prescription Details
SPH
CYL
AXIS
PD DIST
*
PD NEAR
ADD
OC. HEIGHT
*
SEG. HEIGHT
R
▼
▼
▼
L
▼
▼
▼
Note:
ADD fields become mandatory if you select Bifocal, any Progressive option, or Anti-Fatigue.
AXIS fields become mandatory if CYL is not 0 or empty.
LENS TYPE *
Add PRISM
SV / Bifocal
SV Stock
SV Surfaced
Bifocal
Myopia Control Myopi-X
PROGRESSIVES
Prog "OPTIMIST" HMC AR
BEST
Prog "PREMIER" HMC AR
BETTER
Prog "ADVANCED" HMC AR
GOOD
Prog "STANDARD" HMC AR
Basic
TASK SPECIFIC
Anti-Fatigue: DigitalEase
Work Lenses :
MATERIAL /TREATMENT
Transitions™
Transitions XTRActive
Photosition
Polarized
Tint
COATING
(Max 2)
EasyClean HMC AR
HMC AR
Hard Coat
Backside AR Only
Blue Block UV420
COLOUR
Grey
Brown
G15
Other
MATERIAL / INDEX
*
1.50
1.56
Poly
1.60
1.67
1.74
FRAME SIZE
*
A
B
DBL
ED
FRAME TYPE
*
Full Metal
Full Plastic
Groove
Drilled Rimless
JOB TYPE
*
Uncut
Frame To Follow
Frame Enclosed
Lab To Supply Frame
FRAME BRAND
FRAME BRAND
Select...
DESPADA
HERMOSSA
BLANCIA
DIVERSO
CERRUTI 1881
Other
Select...
MODEL
COLOR
SPECIAL INSTRUCTIONS / SHAPE TRACE
TINT INSTRUCTIONS
Submit Order