SELECT EYEWEAR
Plastic || $90
Polycarbonate || $190
1.67 High Index || $240
SINGLE VISION PRESCRIPTION LENSES(WITH ANTI-GLARE)$100 BLUE-LIGHT FILTERING LENSES(NON-PRESCRIPTION)$75 FRAME ONLY / DEMO LENSES(DISPLAY LENSES INCLUDED)$0
SELECT EYEWEAR: Lens Material
Total
$0
Anti-Glare $90 Blue light filter $50
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Doctor name
Doctor number
Patient name
PATIENT'S DOB
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