PRESCRIPTION FORM - ZZ medical 2026

1. Click ‘Get Form’ to open the PRESCRIPTION FORM - ZZ medical in the editor.
2. Begin by entering the CUSTOMER NAME and ORDER NUMBER in the designated fields at the top of the form.
3. Select the type of prescription you are submitting by checking one of the three boxes: SINGLE VISION, BIFOCAL, or PROGRESSIVE.
4. For SINGLE VISION prescriptions, fill in the SPHERE, CYLINDER, AXIS, and PRISM BASE for both OD (Right Eye) and OS (Left Eye). Ensure to include PUPILARY DISTANCE as well.
5. If applicable, for BIFOCAL or PROGRESSIVE prescriptions, provide additional details such as ADD BIFOCAL POWER along with other required information.
6. Verify that all Rx information is current for the year before finalizing your submission.
7. Once completed, fax the form to 319-277-3998 or email it to orders@zzmedical.com directly from our platform.

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