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LENS ORDER FORM Clear Form Save Clear OD and OS data Print ORDERED BY: DATE: EMAIL: ACCOUNT #: PATIENT NAME: PO #: SHIPPING: UPS Overnight 2nd Day Ground OTHER NEW PATIENT: Complete ALL FIELDS except

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How to fill out lens order form

How to fill out lens order form:

Start by gathering all necessary information:

01

Write down your personal details such as name, address, and contact information.

02

Note your prescription details including your eye power (diopters), pupillary distance, and any additional lens specifications prescribed by your optometrist.

Select the type of lenses you need:

01

Determine whether you need single vision lenses for distance or reading, bifocal lenses, progressive lenses, or specialized lenses (e.g., for astigmatism).

02

Choose the lens material, such as plastic or polycarbonate, based on your lifestyle and preferences.

03

Consider any additional coatings or features, like anti-glare or UV protection, that you may want to add to your lenses.

Provide your insurance information (if applicable):

01

If you have vision insurance, provide your insurance details, including the name of the insurance company, policy number, and any specific instructions or limitations.

02

If you don't have insurance, you may opt for self-pay and proceed to the next step.

Decide on the frame:

01

If you already have a frame, indicate whether you want to use it or if you need new frames.

02

If you need new frames, browse through the available options at the eyewear store or bring your preferred frame to the optician.

Measure your pupillary distance (PD):

The optician may measure your PD at the store, but if you have the measurement, provide it on the order form. You can ask your optometrist to measure this if needed.

Review and confirm the order details:

01

Double-check all the information you have provided on the form, including your personal details, prescription, insurance information, lens type, frame choice, and PD measurement.

02

If everything is accurate, sign and date the order form to indicate your agreement to proceed with the order.

Who needs lens order form:

Individuals requiring corrective eyewear:

People with nearsightedness (myopia), farsightedness (hyperopia), astigmatism, or presbyopia may need to fill out a lens order form to obtain prescription lenses for optimal vision.

Those seeking new eyeglasses or contact lenses:

Whether you need to replace your current eyewear or simply want a new pair of glasses or contact lenses, a lens order form is necessary to ensure your new eyewear is precisely tailored to your vision needs.

Individuals with vision insurance:

If you have vision insurance coverage, you will likely need to fill out a lens order form with your insurance information for reimbursement or to take advantage of any benefits offered by your policy.

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What is lens order form?

The lens order form is a document used to request the purchase of lenses for eyeglasses or other vision correction devices.

Who is required to file lens order form?

Individuals who require new lenses for their eyeglasses or vision correction devices are required to file a lens order form.

How to fill out lens order form?

To fill out a lens order form, one must provide details such as prescription information, lens type, coating options, and contact information.

What is the purpose of lens order form?

The purpose of the lens order form is to accurately order the correct lenses for eyeglasses or other vision correction devices.

What information must be reported on lens order form?

Information such as prescription details, lens type, coating options, and contact information must be reported on a lens order form.

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