Designer Frames Outlet

Choose your lenses

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Select your RX Type

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Select the material

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Select one or more add-ons

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How would you like to provide your prescription info?

	Sphere	Cylinder	Axis	Add
Right (OD):
Left (OS):

By submitting this form you authorize us to obtain your prescription directly from your doctor.

Patient's Name

Patient's Date Of Birth

Doctor's Name

Doctor's Phone Number

Doctor's Fax Number

Pupilary Distance (PD)

Right PD

Left PD

Type of Add Power

Reading Power:

Tell Us about your frame or any other requests.

Send me a box and label to ship my frames.

Email me a shipping label and I will use my own box.

Summary

Lens Type
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RX Type
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Material
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${{currMaterial.Price}}
Add-Ons
{{addon.Title}} - ${{addon.Price}}

${{addonstotal}}
Total (USD) ${{summarytotal}}

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