1. 1

   Enter your rx and quantity per eye

   Edit
   Right Eye

   Base Curve

   Select

   • 7.5
   • 7.7
   • 7.9

   Diameter

   Select

   • 11.3

   Power

   Select

   • +23.00
   • +26.00
   • +29.00
   • +32.00

   • -0.25
   • -0.50
   • -0.75
   • -1.00
   • -1.25
   • -1.50
   • -1.75
   • -2.00
   • -2.25
   • -2.50
   • -2.75
   • -3.00
   • -3.25
   • -3.50
   • -3.75
   • -4.00
   • -4.25
   • -4.50
   • -4.75
   • -5.00
   • -5.25
   • -5.50
   • -5.75
   • -6.00
   • -6.25
   • -6.50
   • -6.75
   • -7.00
   • -7.25
   • -7.50
   • -7.75
   • -8.00
   • -8.25
   • -8.50
   • -8.75
   • -9.00
   • -9.25
   • -9.50
   • -9.75
   • -10.00
   • -10.25
   • -10.50
   • -10.75
   • -11.00
   • -11.25
   • -11.50
   • -11.75
   • -12.00
   • -12.25
   • -12.50
   • -12.75
   • -13.00
   • -13.25
   • -13.50
   • -13.75
   • -14.00
   • -14.25
   • -14.50
   • -14.75
   • -15.00

   Quantity *

   1

   • 0
   • 1
   • 2
   • 3
   • 4

   -- Please Select --0 1 2 3 4

   Left Eye

   Base Curve

   Select

   • 7.5
   • 7.7
   • 7.9

   Diameter

   Select

   • 11.3

   Power

   Select

   • +23.00
   • +26.00
   • +29.00
   • +32.00

   • -0.25
   • -0.50
   • -0.75
   • -1.00
   • -1.25
   • -1.50
   • -1.75
   • -2.00
   • -2.25
   • -2.50
   • -2.75
   • -3.00
   • -3.25
   • -3.50
   • -3.75
   • -4.00
   • -4.25
   • -4.50
   • -4.75
   • -5.00
   • -5.25
   • -5.50
   • -5.75
   • -6.00
   • -6.25
   • -6.50
   • -6.75
   • -7.00
   • -7.25
   • -7.50
   • -7.75
   • -8.00
   • -8.25
   • -8.50
   • -8.75
   • -9.00
   • -9.25
   • -9.50
   • -9.75
   • -10.00
   • -10.25
   • -10.50
   • -10.75
   • -11.00
   • -11.25
   • -11.50
   • -11.75
   • -12.00
   • -12.25
   • -12.50
   • -12.75
   • -13.00
   • -13.25
   • -13.50
   • -13.75
   • -14.00
   • -14.25
   • -14.50
   • -14.75
   • -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

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