| |
|
|
O.D |
|
O.S |
| Central base curve value: |
|
|
|
|
| |
|
|
|
|
| Fitting curve value: |
|
|
|
|
| |
|
|
|
|
| Diameter: |
|
|
|
|
| |
|
|
|
|
| Power: |
|
|
|
|
| |
|
|
|
|
|
|
| Edge lift configuration: |
|
|
|
|
Please check one |
|
|
Standard |
|
Standard |
|
|
|
or |
|
or |
|
|
Steep |
|
Steep |
|
or |
|
or |
|
| Flat |
|
Flat |
ACT (Asymmetric Corneal Technology) |
|
|
|
|
Please check one if required |
|
|
Grade #1 |
|
Grade #1 |
|
|
|
or |
|
or |
|
|
Grade #2 |
|
Grade #2 |
|
or |
|
or |
|
| Grade #3 |
|
Grade #3 |
|
You can fax your order at 1-603-627-3280 |