Eyeglass Prescription
Eyeglass Prescription
Patient Information:
-
Patient Name: Jarrett Bailey
-
Date of Birth: 11/06/2050
-
Date of Examination: 10/16/2076
Vision Assessment:
|
Eye |
Sphere (SPH) |
Cylinder (CYL) |
Axis (AXIS) |
Add (Near Vision) |
|---|---|---|---|---|
|
Right (OD) |
-2.50 |
-1.00 |
180 |
+2.00 |
|
Left (OS) |
-2.75 |
-0.75 |
175 |
+2.00 |
Pupillary Distance (PD):
-
PD: 62 mm
Additional Information:
-
Lens Type: Single Vision
-
Lens Material: Polycarbonate
-
Coating: Anti-Reflective
Doctor's Information:
-
Doctor's Name: [YOUR NAME]
-
License Number: 12345678
Important Notes:
-
This prescription is valid until: 10/16/2077.
-
Follow-up examination recommended within 1 year.
For Inquiries:
If you have any questions regarding this prescription, please contact:
-
[YOUR COMPANY NAME]
-
Phone: [YOUR COMPANY NUMBER]
-
Email: [YOUR COMPANY EMAIL]
Disclaimer:
This prescription is tailored to the individual needs of the patient and should only be used as directed. Always consult with your eye care professional for any concerns.
