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
Myopi-X
Myopi-X Circle
PROGRESSIVES
Novax "NEXUS 4D"
BEST
Novax "MATRIX HD"
BETTER
Novax "GENIUS"
GOOD
Novax "NOVUM NG"
Basic
TASK SPECIFIC
Anti-Fatigue: DigitalEase
Work Lenses :
MATERIAL /TREATMENT
Transitions™
Transitions XTRActive
Wizard EON
Polarized
Tint
Blockage UV420
COATING
*
(Max 2)
SLC (HC Only)
PixAR GRANITE (HMC+)
PixAR BLUV (UV 420)
PixAR AQUA
I. PixAR (Backside AR)
CLC (HC Only)
COLOUR
Grey
Brown
G15
Other
MATERIAL / INDEX
*
1.50
1.58
Q-vex 1.61
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
DESPADA CLUB
HERMOSSA
BLANCIA
DIVERSO
CERRUTI 1881
Other
Select...
MODEL
COLOR
SPECIAL INSTRUCTIONS / SHAPE TRACE
TINT INSTRUCTIONS
Submit Order