LabOrderForm

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VSP Optics - Lab Order Form

(Updated May 14th, 2024)

Practice Location:

AUS NZ

Account #

Practice Name

Practice Email Address

Job Reference

Order Type

Sun.RX | Standard Order

Standard Order

Order Type/Supply Code

Promotional Offer

Brand

Make

Model

Colour

EyeSize

Bridge

Depth

Diag

Lenses - Standard Order

Lens Type

SV Lenses (Stock)

Clear SunSync Tinted and Polarised lenses

SV Lenses (Grind - Clear)

SV Lenses (Grind - SunSync)

SV Lenses (Grind - Sun/Polarised)

Anti Fatigue Lenses (1.50)

Anti Fatigue Lenses (1.53)

Anti Fatigue Lenses (1.59)

Anti Fatigue Lenses (1.60)

Anti Fatigue Lenses (1.67)

Anti Fatigue Lenses (1.74)

FT28 FT35 Tinted and Polarised lenses

Bifocal Lenses (FT28)

Bifocal Lenses (FT35)

Bifocal Lenses (Sun.RX)

Occupational / Progressive Near Lenses 1.50

Occupational / Progressive Near Lenses 1.53

Occupational / Progressive Near Lenses 1.59

Occupational / Progressive Near Lenses 1.60

Occupational / Progressive Near Lenses 1.67

Occupational / Progressive Near Lenses 1.74

Clear SunSync Photochromatic Tinted and Polarised lenses

Freeform Lenses VSP (Clear - Unity Via Elite 1.50)

Freeform Lenses VSP (Clear - Unity Via Elite 1.53)

Freeform Lenses VSP (Clear - Unity Via Elite 1.59)

Freeform Lenses VSP (Clear - Unity Via Elite 1.60)

Freeform Lenses VSP (Clear - Unity Via Elite 1.67)

Freeform Lenses VSP (Clear - Unity Via Elite 1.74)

Freeform Lenses VSP (Clear - Unity Via Plus 1.50)

Freeform Lenses VSP (Clear - Unity Via Plus 1.53)

Freeform Lenses VSP (Clear - Unity Via Plus 1.59)

Freeform Lenses VSP (Clear - Unity Via Plus 1.60)

Freeform Lenses VSP (Clear - Unity Via Plus 1.67)

Freeform Lenses VSP (Clear - Unity Via Plus 1.74)

Freeform Lenses VSP (Clear - Unity Via 1.50)

Freeform Lenses VSP (Clear - Unity Via 1.53)

Freeform Lenses VSP (Clear - Unity Via 1.59)

Freeform Lenses VSP (Clear - Unity Via 1.60)

Freeform Lenses VSP (Clear - Unity Via 1.67)

Freeform Lenses VSP (Clear - Unity Via 1.74)

Freeform Lenses VSP (Clear - Diamond)

Freeform Lenses VSP (Clear - Platinum 1.50)

Freeform Lenses VSP (Clear - Platinum 1.53)

Freeform Lenses VSP (Clear - Platinum 1.59)

Freeform Lenses VSP (Clear - Platinum 1.60)

Freeform Lenses VSP (Clear - Platinum 1.67)

Freeform Lenses VSP (Clear - Platinum 1.74)

Freeform Lenses VSP (Clear - Gold 1.50)

Freeform Lenses VSP (Clear - Gold 1.53)

Freeform Lenses VSP (Clear - Gold 1.59)

Freeform Lenses VSP (Clear - Gold 1.60)

Freeform Lenses VSP (Clear - Gold 1.67)

Freeform Lenses VSP (Clear - Gold 1.74)

Freeform Lenses VSP (Clear - White Label)

Freeform Lenses VSP (SunSync - Unity Via Elite 1.50)

Freeform Lenses VSP (SunSync - Unity Via Elite 1.53)

Freeform Lenses VSP (SunSync - Unity Via Elite 1.59)

Freeform Lenses VSP (SunSync - Unity Via Elite 1.60)

Freeform Lenses VSP (SunSync - Unity Via Elite 1.67)

Freeform Lenses VSP (SunSync - Unity Via Elite 1.74)

Freeform Lenses VSP (SunSync - Unity Via Plus 1.50)

Freeform Lenses VSP (SunSync - Unity Via Plus 1.53)

Freeform Lenses VSP (SunSync - Unity Via Plus 1.59)

Freeform Lenses VSP (SunSync - Unity Via Plus 1.60)

Freeform Lenses VSP (SunSync - Unity Via Plus 1.67)

Freeform Lenses VSP (SunSync - Unity Via Plus 1.74)

Freeform Lenses VSP (SunSync - Unity Via 1.50)

Freeform Lenses VSP (SunSync - Unity Via 1.53)

Freeform Lenses VSP (SunSync - Unity Via 1.59)

Freeform Lenses VSP (SunSync - Unity Via 1.60)

Freeform Lenses VSP (SunSync - Unity Via 1.67)

Freeform Lenses VSP (SunSync - Unity Via 1.74)

Freeform Lenses VSP (SunSync - Diamond)

Freeform Lenses VSP (SunSync - Platinum 1.50)

Freeform Lenses VSP (SunSync - Platinum 1.53)

Freeform Lenses VSP (SunSync - Platinum 1.59)

Freeform Lenses VSP (SunSync - Platinum 1.60)

Freeform Lenses VSP (SunSync - Platinum 1.67)

Freeform Lenses VSP (SunSync - Platinum 1.74)

Freeform Lenses VSP (SunSync - Gold 1.50)

Freeform Lenses VSP (SunSync - Gold 1.53)

Freeform Lenses VSP (SunSync - Gold 1.59)

Freeform Lenses VSP (SunSync - Gold 1.60)

Freeform Lenses VSP (SunSync - Gold 1.67)

Freeform Lenses VSP (SunSync - Gold 1.74)

Freeform Lenses VSP (Sun/Polarised)

Freeform Lenses VSP (Photochromatic - White Label)

Additional Coating

Sunglass/Package Details

Brand

Package Code

Package Code

Package Code

Package Code

Package Code

Package Code

Package Code

Instructions:

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Lens Code

Anne Klein Sun.RX

bebe Sun.RX

Coast Sun.RX

CALVIN KLEIN Sun.RX

Nautica Sun.RX

Nike Sun.RX

Nine West Sun.RX

Previous SunRx Model details

Lenses - Sun.RX

Lens Type

SV Sun.RX Lenses

Bifocal Sun.RX Lenses

Freeform Sun.RX Lenses

Sun.RX Colour

Additional Coating

Additional Tinting

Corridor Length

Corridor Length

Corridor Length

Corridor Length

Corridor Length

BVD:

Right

Left

Panto:

Wrap:

Script

Right Eye

Sphere

Cyl

Axis

Add

Vertical Prism

Horiz. Prism

Left Eye

Sphere

Cyl

Axis

Add

Vertical Prism

Horiz. Prism

Fitting Details

PD Near:

Mono Right

Mono Left

PD Distance:

Heights:

Right

Left

Special Instructions

Is everything completed and your order is now ready to submit?