Clearly Correct New Order Form Company Name *Customer code* *Name of the fitter* *E-Mail-Address for requests* *Patient reference *Order NumberRight EyeSphereCylinderAxisAddVertex distanceK flatEcc flatK steepEcc steepAxis flatHVIDIf only mean values for eccentricity are available, please insert the same value in both fields.Left EyeSphereCylinderAxisAddVertex distanceK flatEcc flatK steepEcc steepAxis flatHVIDContact lensesVariant RightMyopiaRelaxHyperopiaMyopia for presbyopiaVariant LeftMyopiaRelaxHyperopiaMyopia for presbyopiaBack surface design RightSwissLens ChoiceSpherical back SurfacePeriphertoric back SurfaceBack surface design LeftSwissLens ChoiceSpherical back SurfacePeriphertoric back SurfaceMaterial choice LeftBoston XO blueBoston XO greenBoston XO purpleBoston XO redMaterial choice RightBoston XO blueBoston XO greenBoston XO purpleBoston XO redReturn optionsClassic+ClassicWithout RetrunUrgent orderyesnoOnly for RELAX Myopia Management:Pupil diameter RightPupil diameter LeftAge of PatientAdditional InformationSend Message
