Prescription Upload Form
Upload your optical prescription or enter details manually to complete your order with premium eyewear lenses.
Customer Information
Please provide your contact details to help us match your prescription with your order.
Full Name
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Email Address
example@example.com
Prescription Upload
Upload a clear image or PDF of your prescription (JPG, PNG, PDF; max 10MB).
Upload Prescription
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Or Enter Prescription Manually
Fill in your prescription details below if you prefer manual entry or cannot upload a file.
Right Eye (OD) Prescription
SPH (Sphere)
CYL (Cylinder)
AXIS
Left Eye (OS) Prescription
SPH (Sphere)
CYL (Cylinder)
AXIS
PD (Pupillary Distance)
Lens Preference
Select your preferred lens type(s) for your eyewear.
Lens Options
Blue Cut
Anti-Glare
Photochromic Day-Night
Premium HD Lens
Zero Power Blue Cut
Additional Notes
Any special instructions or notes regarding your prescription or order.
Additional Notes
Thank you! Our team will verify your prescription and contact you on WhatsApp if needed.
Submit Prescription
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