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Eye Test Result
Please complete this section.
Customer Company
Employee Name
Frame Type
Right Eye
Sphere
*
Cylinder
*
Axis
*
Prism
ADD
Left Eye
Sphere
*
Cylinder
*
Axis
*
Prism
ADD
Lens Material
Lens Material
*
-- Select Lens Material --
Polycarbonate
Lens Type
*
-- Select Lens Type --
Single Vision
Bifocal
Progressive Vision
Single Vision RX
Tinting
Multicoat
Special Instruction
Pupil Distance
Distance PD
Near PD
Submit