New Lens Order - Scotlens.

ACCOUNT INFORMATION

Account Name *

Prescriber Name *

Account Number *

Email Address *

LENS ORDER FORM

Please supply either desired lens specification or ocular measurements.

PX Reference *

EYE MEASUREMENTS OR SKIP TO LENS PAPAMETERS BELOW...

RX Sphere Right

RX Sphere Left

RX Minus Cylinder Right

RX Minus Cylinder Left

RX Axis Right

RX Axis Left

BVD Right

BVD Left

K Flat mm Right

K Flat mm Left

K Steep mm Right

K Steep mm Left

K Steep Along Right

K Steep Along Left

HVID Right

HVID Left

LENS PARAMETERS

BOZR Flat Right

BOZR Flat Left

BOZR Steep Right

BOZR Steep Left

Design Right *

Design Left *

Power Flat Right

Power Flat Left

Power Steep Right

Power Steep Left

Add Right

Add Left

Edge Lift Right

Edge Lift Left

Diameter Right

Diameter Left

Material Right

Material Left

Tint Right

Tint Left

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