Designer Glasses

Name*

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Phone

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Prescription Name*

How will you use your glasses?*

Distance
Reading
Computer

Right Eye

If your prescription falls outside of the range of options below, please contact us directly where we can advise you of the best lens types and prices for your prescription: [email protected]

Sphere (SPH)

This indicates the lens power prescribed to correct long or short-sightedness. If it's "+", you are long sighted. If it's "-", you are short-sighted. If your prescription falls outside of this range we can still accommodate you but please contact us.

Cylinder (CYL)

This indicates correction for astigmatism. If you have nothing entered in this box, then you don't need to be corrected for astigmatism. If your prescription falls outside of this range we can still accommodate you but please contact us.

Axis*

The axis represents the direction of the CYL. If you don't need to be corrected for CYL, you won't have an axis.

Please enter a number from 1 to 180.

Near Addition (ADD)

This is the extra magnification you need to see close objects in addition to the long distance prescription. It is usually the same for both eyes.

Left Eye

Sphere (SPH)

This indicates the lens power prescribed to correct long or short-sightedness. If it's "+", you are long sighted. If it's "-", you are short-sighted. If your prescription falls outside of this range we can still accommodate you but please contact us.

Cylinder (CYL)

This indicates correction for astigmatism. If you have nothing entered in this box, then you don't need to be corrected for astigmatism. If your prescription falls outside of this range we can still accommodate you but please contact us.

Axis*

The axis represents the direction of the CYL. If you don't need to be corrected for CYL, you won't have an axis.

Please enter a number from 1 to 180.

Near Addition (ADD)

This is the extra magnification you need to see close objects in addition to the long distance prescription. It is usually the same for both eyes. If your prescription falls outside of this range we can still accommodate you but please contact us.

Pupillary Distance:*

If not on your prescription you can measure yourself, please see FAQ’s on how to measure your PD. If your prescription falls outside of this range we can still accommodate you but please contact us.

Date of prescription:*

Extra Information:

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I certify that the wearer is over 16 years old and that they are not registered blind or partially sighted. I also confirm that the prescription details above have been entered correctly, the prescription is current and I am happy that no errors have been made.

Comments

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Left Eye

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