BARRIERS GLASSES Prescription Order Form 2025

1. Click ‘Get Form’ to open the BARRIERS GLASSES Prescription Order Form in the editor.
2. Begin by entering your company name and phone number at the top of the form. This information is essential for processing your order.
3. Fill in the Purchase Order #, Patient Name, and Date fields to ensure accurate tracking of your prescription order.
4. Provide the Ship to Address, including City, State, and Zip code. This ensures that your glasses are delivered to the correct location.
5. Select the Glasses Model # and specify the Type of Script required (Single Vision, Bifocal, etc.). Make sure to fill in all relevant fields for each eye (R for Right and L for Left).
6. Input measurements for Pupillary Distance (PD) and Segment Height (SH) as indicated. Remember that PD is crucial for Single Vision orders, while both PD and SH are necessary for Bifocal/Progressive orders.
7. Finally, ensure that a Dispensing Optician's signature is included before submitting. You can then mail or fax the completed form to Infab using the provided contact details.

Start filling out your BARRIERS GLASSES Prescription Order Form online for free today!