Name :		Age :		Sex :	M F
Mobile :		Email :

 

	RIGHT EYE			LEFT  EYE
	SPH	CYL	AXIS	SPH	CYL	AXIS
D.V.
N.V

 

PD :
INSTRUCTIONS - (if any) :

 

TYPE OF PRODUCT		GLASS
		PLASTIC / CR-39
TYPE OF LENS		SINGLE VISION (S/V)
		KT
		D-BIFOCAL
		EXECUTIVE
		PROGRESSIVE
LENS QUALITY		UNCOAT (U/C)
		HARDCOAT (H/C)
		ANTI REFLECTION (ARC)