1. 1

   Enter your rx and quantity per eye

   Edit
   Right Eye

   Base Curve

   8.6

   • 8.6

   -- Please Select --8.6

   Diameter

   14.0

   • 14.0

   -- Please Select --14.0

   Power

   Select

   • -12.50
   • -13.00
   • -13.50
   • -14.00
   • -14.50
   • -15.00
   • -15.50
   • -16.00
   • -16.50
   • -17.00
   • -17.50
   • -18.00
   • -18.50
   • -19.00
   • -19.50
   • -20.00

   • +8.50
   • +9.00
   • +9.50
   • +10.00
   • +10.50
   • +11.00
   • +11.50
   • +12.00
   • +12.50
   • +13.00
   • +13.50
   • +14.00
   • +14.50
   • +15.00

   -- Please Select ---12.50 -13.00 -13.50 -14.00 -14.50 -15.00 -15.50 -16.00 -16.50 -17.00 -17.50 -18.00 -18.50 -19.00 -19.50 -20.00 +8.50 +9.00 +9.50 +10.00 +10.50 +11.00 +11.50 +12.00 +12.50 +13.00 +13.50 +14.00 +14.50 +15.00

   Quantity *

   1

   • 0
   • 1
   • 2
   • 3
   • 4

   -- Please Select --0 1 2 3 4

   Left Eye

   Base Curve

   8.6

   • 8.6

   -- Please Select --8.6

   Diameter

   14.0

   • 14.0

   -- Please Select --14.0

   Power

   Select

   • -12.50
   • -13.00
   • -13.50
   • -14.00
   • -14.50
   • -15.00
   • -15.50
   • -16.00
   • -16.50
   • -17.00
   • -17.50
   • -18.00
   • -18.50
   • -19.00
   • -19.50
   • -20.00

   • +8.50
   • +9.00
   • +9.50
   • +10.00
   • +10.50
   • +11.00
   • +11.50
   • +12.00
   • +12.50
   • +13.00
   • +13.50
   • +14.00
   • +14.50
   • +15.00

   -- Please Select ---12.50 -13.00 -13.50 -14.00 -14.50 -15.00 -15.50 -16.00 -16.50 -17.00 -17.50 -18.00 -18.50 -19.00 -19.50 -20.00 +8.50 +9.00 +9.50 +10.00 +10.50 +11.00 +11.50 +12.00 +12.50 +13.00 +13.50 +14.00 +14.50 +15.00

   Quantity *

   1

   • 0
   • 1
   • 2
   • 3
   • 4

   -- Please Select --0 1 2 3 4

2. 2

   Verification

   Edit

   How can we verify your RX? *

   • Upload
   • On File
   • Email

     Please e-mail a picture or scan of your RX to rx@lookingglassvision.com

   -- Please Select --Upload On File Email

   Upload

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