Your Name (First and Last)
Email
Phone
Style and Color of Sunglasses
Date
PD (Doctor Supplied)
Additional Comments
You must
fax your prescription to
901-683-3441
Form Below is for Contacts
BC = Base Curve Dia. = Diameter
Eye
Power
BC
Dia.
Qty.
R
(OD)
Select
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.50
-7.00
-7.50
-8.00
-8.50
-9.00
-9.50
-10
-10.5
-11
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
+6.50
+7.00
+7.50
+8.00
Select
8.4
8.8
9.1
Select
14.0
14.4
None
1 Box
2 Boxes
3 Boxes
4 Boxes
5 Boxes
6 Boxes
7 Boxes
8 Boxes
9 Boxes
10 Boxes
11 Boxes
12 Boxes
13 Boxes
14 Boxes
15 Boxes
16 Boxes
17 Boxes
18 Boxes
19 Boxes
20 Boxes
L
(OS)
Select
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.50
-7.00
-7.50
-8.00
-8.50
-9.00
-9.50
-10
-10.5
-11
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
+6.50
+7.00
+7.50
+8.00
Select
8.4
8.8
9.1
Select
14.0
14.4
None
1 Box
2 Boxes
3 Boxes
4 Boxes
5 Boxes
6 Boxes
7 Boxes
8 Boxes
9 Boxes
10 Boxes
11 Boxes
12 Boxes
13 Boxes
14 Boxes
15 Boxes
16 Boxes
17 Boxes
18 Boxes
19 Boxes
20 Boxes
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