RB 2185 Ray Ban

RB 2185 Ray Ban

Sale
Regular price Rs. 7,890.00

Eye Prescription Form

Eye Prescription Form

Patient Name:

Date of Birth:

Prescription Date:

OD (Right Eye) Sphere (SPH):

OS (Left Eye) Sphere (SPH):

OD (Right Eye) Cylinder (CYL):

OS (Left Eye) Cylinder (CYL):

OD (Right Eye) Axis:

OS (Left Eye) Axis:

OD (Right Eye) Addition (ADD):

OS (Left Eye) Addition (ADD):

Pupillary Distance (PD):

Additional Notes: