Glasses Prescription Order Form - Infab 2026

1. Click ‘Get Form’ to open the Glasses Prescription Order Form - Infab in the editor.
2. Begin by entering your Company Name and Telephone # at the top of the form. This information is essential for processing your order.
3. Fill in the Company Purchase Order # and Patient’s Name to ensure accurate identification of the order.
4. Provide the Date and Ship to Address, including City, State, and Zip code, so that your glasses can be delivered promptly.
5. Select the Glasses Model # and Lead Equivalency. Specify the Type of Script by checking either Single Vision, Bifocal, or Bifocal Progressive.
6. Complete the Prescription section by filling in Sphere, Cylinder, Bifocal/Progressive Add, and Axis for both Right (R) and Left (L) eyes.
7. Ensure you include PD (Pupillary Distance) and Segment Height as required for processing. Remember that PD is mandatory for Single Vision orders, while both PD & Segment Height are needed for Bifocal/Progressive orders.
8. Finally, obtain the Dispensing Optician's Signature before submitting your form. You can then photo copy this form and mail or fax it to Infab Corporation using the provided contact details.

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