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]

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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.

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