Complete la siguiente información y uno de nuestros representantes se encargará de procesar su orden:

Datos Generales:

 

Su Nombre:

Numero de Cuenta:

Email:

Dirección:

Pueblo y Zip Code:

Teléfono:

 

Paciente:

 

Nombre del Paciente:

PO NUMBER:

 

Receta:

 

SPHERE

CYLINDER

AXIS

PRISM 

DIRECTION

Right

Left

 

ADD

SEG HGT

OC HGT

BASE CURVE

Right

 

Left

 

PD:

  Distance    Near

   

Lens Only (uncut)

Frame to Come

Frame Included

   

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Información de Frame:

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Eye Size: B: ED: DBL:

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Frame Name:

Manufacturer:

Frame Color:

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 CR PLASTIC LENSES
.
Single Vision 70mm Progressive Outlook (Up to 18 Seg Height)
Ft-28 70mm Adds from 1.00 up to 2.75D Progressive Image (Up to 18 Seg Height)
Ft-35 70mm Progressive Essilor Ovation (Up to 17 Seg Height)
Ft-45 80mm Progressive Compact (Up to 17 Seg Height)
Executive 68mm Progressive Interview (Computer Users)
Executive 75mm Progressive Varilux Comfort
Occupational Progressive Varilux Elipse (Up to 14 Seg Height)
Trifocal 7 X 28 70mm Progressive Panamic
Trifocal Executive 70mm Lenticular S.V.
Trifocal 8 X 35 70mm Lenticular Round Seg
Trifocal Executive 70mm Lenticular Ft-22
Ultex Round 40 Segment 70mm Super Modular S.V.
Round 22 Segment 70mm Super Modular Bifocal
Blended 28mm seg
Progressive Truvision (Up to 20 Seg Height)
.
 HI-INDEX (1.60) 
.
Single Vision Progressive Essilor Ovation (Hi-index 1.67)
Ft-28 Varilux Comfort Ormex (Hi-index 1.60)
Progressive Image Panamic Ormex (Hi-index 1.60)
...
 GLASS CLEAR
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Single Vision 71.5mm Round 22 Segment 71.5mm
Ft-28 71.5mm Progressive Variview or Outlook 71mm
Ft-35 71.5mm Varilux Comfort
Trifocal 7 x 35
Trifocal 7 x 28 71.5mm
...
 POLYCARBONATE LENSES
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Single Vision Progressive Adaptar Airwear (21 Seg Height)
Ft-28 Progressive Image (18 Seg Height)
Ft-35 Progressive Essilor Ovation Airwear (17 Seg Height)
Trifocal 7 x 28 Progressive Compact Rugget (17 Seg Height)
Trifocal 7 x 35 Progressive Varilux Comfort Airwear
Progressive Outlook Tegra (18 Seg Height) Progressive Panamic Airwear
  
...
 YOUNGER TRILOGY
  
Single Vision Image Clear
Ft-28 Clear Image Transitions Next Gen Grey
Single Vision Transitions Next Gen Grey
  
...
 TRANSITION NEXT GENERATIONS 1.501 INDEX
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 Color   CR 601 Progressive Compact Transitions Next Gen
CR 601 Single Vision CR 601 Varilux Comfort Transitions Next Gen Grey
CR 601 Ft-28 CR 601 Oanamic Transitions Next Gen Grey
CR 601 Ft-35 Poly Transitions S.V. Aspheric
CR 601 Trifocal Ft-28 Poly Transitions Outlook Tegra
CR 601 Trifocal Ft-35 Poly Transitions Progressive Image
CR 601 Progressive Outlook Transitions Next Gen Ovation Airwear Transitions Grey
CR 601 Progressive Image Transitions Next Gen Trilogy Single Vision Trans Next Gen Grey
CR 601 Progressive Essilor Ovation Transition Next Gen Trilogy Image Trans Next Gen Grey
Panamic Airwear Transitions Grey
   
 GLASS PHOTO GREY (PGX) / PHOTO BROWN (PBX)
..
Single Vision PGX Executive PGX
Single Vision PBX Executive PBX
Ft-28 PGX Progressive Outlook PGX
Ft-28 PBX Progressive Outlook PBX
Ft-35 PGX Progressive Varilux Comfort PGX
Trifocal 7 x 28 PGX
.
 POLARIZED LENSES GREY & BROWN
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 Color 

CR39 Panamic Nu-Polar
CR39 Single Vision Poly Single Vision
CR39 Ft-28 Poly Ft-28 SunRx
CR39 Progressive Image Nu-Polar Poly Progressive Outlook Tegra SunRx
CR39 Varilux Comfort Nu-Polar Poly Progressive Image Nu-Polar
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 POLARIZED MELANINE BROWN
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Poly Single Vision Melanine Poly Progressive Outlook Melanine
  
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 SUNRX POLARIZED MIRROR COATING
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Poly Single Vision Grey Mirror Coating Poly Single Vision Gold Mirror Coating
Poly Single Vision Blue Mirror Coating
.

 

  ADDITIONAL FEATURES
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UV-400 Metal Frame
Scratch Resistance Coating for CR39 Lenses (Coating only, not a warranty) Polish Edges
Scratch Warranty CR39 Single Vision & Ft-28 Roll & Polish
Scratch Warranty CR39 Progressive (Image, Truvision, Outlook) Rimless
Scratch Warranty Transition CR601 Single Vision Drill Groove
Scratch Warranty Polarized CR39 Single Vision Faceted Lenses
Reflection Free Anti-reflective coating Hand Made Lenses (Frames w vertical <25mm)
Crizal Coating Nose Pads (Pair)
Mirror Coating Nylon replacement
Solid Tint Plastic Lenses Screw Replacement
Gradient Tint Plastic Lenses Remove & Replace Screw
Multicolor Tint Plastic Lenses Ultralite Style SPH 5.00 Diopter or over
Solid Tint Polycarbon Lenses Ultralite Style
Gradient Tint Polycarbon Lenses Ultralite Style Cyl 3.00 Diopter or over
Multicolor Tint Polycarbon Lenses Ultrasonic Frame Cleansing
Cut & Edges Customer Lenses Doble Concavo CR39, Poly, Hi-Index
Lens Adaptation

TINT COLOR    TINT COLOR      PERCENTAGE

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  MISCELANEOUS
 
 

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Comentarios o instrucciones especiales:

 

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