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What do you use your glasses for?

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Choose the thickness of the lenses

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Choose the way to fill the prescription

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Fill it out online

Have 2 PD numbers

Need your Pupillary Distance measured?

Click the app below or provide us with your eye doctor's contact information and we will reach out for your Pupillary Distance measurement and verify prescription.

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Need help getting your Pupillary Distance (PD)?

Please provide your doctor's information if you would like us to contact your eye doctor's office for your Pupillary Distance measurement.

Customer First Name *

Customer Last Name *

Date of Birth *

Customer Phone *

Doctor's Name / Office Name *

Doctor Office Phone *

My prescription includes prism($35.00)

	Vertical (Δ)	Base Direction	Horizontal (Δ)	Base Direction
OD	0 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00	n/a Up Down	0 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00	n/a In Out
OS	0 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00	n/a Up Down	-0 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00	n/a In Out

Upload your prism file in any of the following formats: PDF, JPG, GIF, PNG, JPEG

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* By checking this box, you affirm that you possess a valid eyeglass prescription that is less than two (2) years old and issued by a licensed optometrist or ophthalmologist. You acknowledge that you are solely responsible for providing accurate and up-to-date prescription information upon request.

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