LAUREATES   Model #5-1
The following information is needed to match your prescription to your order.
First Name:  
Last Name:  
Email Address:  
Zip Code:   

LAUREATES

If you do not have your prescription information readily available, you may place your order and provide your prescription information to us using our toll free number ( 1 800 332 3534 ), email address ( information@focusers.com ), or fax (215 574 0310) at a later date. If the information is only available through your local eye doctor, you are entitled, by law, to a free copy of your prescription.

If you would like us to request your prescription, simply advise your doctor in advance that we will be calling, and to provide your prescription information to Focusers. Once you've contacted your eye doctor, provide us with your doctor's name and telephone number.

Important Note Regarding Progressive Bifocal Lenses


Progressive Bifocals (aka "no line" bifocals)     $165.00 additional charge.

Due to the need for precise measurements when filling progressive bifocal prescriptions we ask all who wish to order progressive lenses to call (1-800-332-3534) between the hours of 9:00am and 3:00pm EST to place the order. Please have your prescription information handy. If you wish to order our standard "line" (or "visible") bifocals at a $45.00 additional charge, ($75.00 in a rimless frame) simply continue with your order, check the bifocal option when encountered in the following pages.

Please use the comments area at the end of this form to tell us how we can further help you.


Please select the mode in which Focusers should obtain your prescription information.
I am entering my prescription information in the chart below.

I have asked my eye doctor to send my prescription information via fax.

I have informed my eye doctor that Focusers will be calling for my prescription information.
      My doctors name and number are provided in the "text-input" area below.

Please note that your prescription may not contain all the information found in the chart below. Fill in only the boxes that correspond with the information that you have available. Also note that we are unable to fill prescriptions higher than a -7:00 or +3.00 (example -7.1, -8.0 -9.0 or +3.1, +4.0, +5.0) If you are unsure about your prescription do not hesitate to call us at 1 800 332 3534, we'll be more than happy to help you.

Please note: for SPH and CYL you MUST enter the "+" or "-" symbol (example +1.00 or -1.00)
Lenses:

Sph

Cyl

Axis

Prism

Base

Seg Ht

R(OD)
L(OS)
PD:

ADD: (Bifocals)

TEXT INPUT AREA
Please provide us with any further information that may aid in the filling of your order. If you have your eye-doctors name and number handy you may enter that information as well.