Prescription Form

Spectacles.GB |  Prescription Form

Please Fill In Your Prescription Details:


Right Eye Prescription Details
SPH CYL Axis Add

Left Eye Prescription Details
SPH CYL Axis Add

PD (Pupil Distance)
PD    

Lens Options (Please tick one of the following boxes)
CR39 - Standard Hardcoated Lens (Free)
CR39 Hardcoated lens with tint (£15.00)
Colour    
CR39 - Transitions (£50.00)
Colour    
Polycarb 1.59 Hardcoated Lens (£20.00)
Polycarb 1.59 Hardcoated with MAR coating (£40.00)
Polycarb 1.59 Transitions with MAR coating (£100.00)
Colour    
CR39 1.67 with MAR coating (£60.00)
CR39 1.67 Transitions with MAR coatings (£150.00)
Colour    
CR39 1.74 with MAR coating (£100.00)

Your Spectacles Are For? (Please tick one of the boxes below)
Distance
Reading

Spectacles.GB |  Prescription Form