Company Name

Customer Code

Name of the fitter

Patient reference

Order number

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Sphere

Cylinder

Axis

Add

Vertex distance (mm)

K flat

Ecc flat

K steep

Ecc steep

Axis flat

If only mean values for eccentricity are available, please insert the same value in both fields.

HVID

Pupil size

Variant

Backsurface design

Material

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