RANGER Order

   NAME          

ADDRESS       

 POST CODE            TELEPHONE  

EMAIL            

 Prescription detail

IF NON PRESCRIPTION REQUIRED LEAVE BLANK

                    SPHERE                   CYL                       AXIS                 

RIGHT EYE SELECT -6.00 -5.75 -5.50 -5.25 -5.00 -4.75 -4.50 -4.25 -4.00 -3.75 -3.50 -3.25 -3.00 -2.75 -2.50 -2.25 -2.00 -1.75 -1.50 -1.25 -1.00 -0.75 -0.50 -0.25 0.00 +0.25 +0.50 +0.75 +1.00 +1.25 +1.50 +1.75 +2.00 +2.25 +2.50 +3.00 +3.25 +3.50 +3.75 +4.00 +4.25 +4.50 +5.00 +5.25 +5.50 +5.75 -5.00 +6.00            SELECT NOT USED +2.00 +1.75 +1.50 +1.25 +1.00 +0.75 +0.50 +0.25 0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00         SELECT NOT USED 180 175 170 165 160 155 150 145 140 135 130 125 120 115 110 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5             

LEFT EYE    SELECT -6.00 -5.75 -5.50 -5.25 -5.00 -4.75 -4.50 -4.25 -4.00 -3.75 -3.50 -3.25 -3.00 -2.75 -2.50 -2.25 -2.00 -1.75 -1.50 -1.25 -1.00 -0.75 -0.50 -0.25 0.00 +0.25 +0.50 +0.75 +1.00 +1.25 +1.50 +1.75 +2.00 +2.25 +2.50 +3.00 +3.25 +3.50 +3.75 +4.00 +4.25 +4.50 +5.00 +5.25 +5.50 +5.75 -5.00 +6.00            SELECT NOT USED +2.00 +1.75 +1.50 +1.25 +1.00 +0.75 +0.50 +0.25 0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00          SELECT NOT USED 180 175 170 165 160 155 150 145 140 135 130 125 120 115 110 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5            

WE CAN ONLY SUPPLY PRESCRIPTIONS WHICH CAN BE COVERED BY DETAILS IN THE SELECTION TABLES.

 Ranger type  PLEASE SELECT NON PRESCRIPTION.... £31.00 PRESCRIPTION TYPE...........£41.00                     

  PLEASE POST A CHEQUE TO COVER RANGER TYPE..

MADE OUT TO "AXIS OPTICAL"

AND POST TO

AXIS OPTICAL

99 CARLISLE STREET EAST

SHEFFIELD

S4  7QN

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