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VR RX LENSES
Online Form - VR Insert Rx Lenses
Adult Rimless Eyewear
(Over 18 Years Old)
(Take Advantage By Using Your Flex Spending or Health Savings Card)
Step #1: Promotion
*
Indicates required field
Interested in Current Promo ($25.00 OFF and FREE Domestic Shipping)
*
Yes!
No
Not Sure...
Step #2: Patient Information
Patient's Name
*
First
Last
Patient's Date of Birth (MM/DD/YYYY)
*
Phone Number
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Email
*
Step #3: Shipping & Billing Information
Home/Shipping Address
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Line 1
Line 2
City
State
Zip Code
Country
Is Billing the same as Shipping Address??
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Yes
No
(If "No'", Please enter billing information below)
Billing Information: (Street, City, State, Zip, and Country)
*
Step #4: Rx Information
Please email or upload a copy of the original Rx
.
We will not process the order until we receive a copy of your prescription.
(Our Email Address: billcurran2020@gmail.com) Please email us your Rx ASAP if you are not uploading it within the form
Upload Photo Copy of Rx
*
Max file size: 20MB
Additional information. (Eye Disorders, Etc.)
*
Step #5: Send Us
Four
Photos of Yourself (18-20 Inches Away)
- Facial Shots Only-
1 photo with a standard size business card or license ID
(hold it horizontally under your nose with no eyewear on)
Photo Holding Card Under Nose
*
Max file size: 20MB
2 photos without eyewear
No Eyewear #1
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Max file size: 20MB
No Eyewear #2
*
Max file size: 20MB
1 photo with present eyewear (if you have a pair)
Current Eyewear (If Present)
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Max file size: 20MB
Step #6: Select a Frame Design (Based on if a Patient is Over 18 Years Old)
- Each Frame Collection Can Be Viewed Below Under Their Available Colors -
Available Frame Design
*
Dynamics Colorwave (Retail Price: $339.00)
- Frame Colors Below are for
Dynamics Colorwave Collection
(w/ Hinges) Only -
Available Frame Colors (Dynamics Colorwave Colors Only)
*
Cherry Red (3040)
Purple Papaya (4040)
Khaki Brown (6040)
Ocean (6660)
Gold/Plum (7530)
Black/Slate (9040)
Raspberry (3530)
Teal/Pineapple (5040)
Ruthenium/Palm (6560)
Rhodium/Lapis (7000)
Taupe/Cotton (8540)
Black/Clear (9140)
Note Sure....
Patient is Under 18 (Skip this Question)
Step #8: Lens Shapes
All of our work is customized. Once we receive the close up facial photos of the patient, we will email or call you (or the parent) and discuss lens shapes that we recommend. If desired, we can email a superimposed image of the lens shape over the photo you sent us for a general idea on how they will look. These lenses are not one-size-fits-all.
Step # 9:
Extra Add-Ons Available
Blue Light Blocker ($30.00 Extra Fee Over Crizal Avance (A/R Coating)
- Optional Lens Add-On But
We Highly Recommend Anti Coating Regardless if it's Avance or Blue Light Blocker -
Interested in Blue Light Blocker?
*
Yes
No
Not Sure...
Prevencia™: Light can be beneficial in your everyday life!!
Light is fundamental for vision.
Color perception, shapes and details.
Blue-Turquoise Light aids in your overall well-being.
Sleep/wake cycles, memory and basic mental functioning.
Any Interest in Transitions 8? ($140.00 Extra for Adult | $120.00 Extra for Child)
*
Yes!
Maybe, tell me more about it.
Not Interested
Submit Form By Clicking Button Below
Note: All fields with an
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are a mandatory field. Forms won't go through otherwise.
Make sure to hit the submit button when you're finished. If mandatory fields are left unanswered, they will be circled in red.
Submit Online Form for Adult Rimless Eyewear
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About Us
VR RX LENSES
Online Form - VR Insert Rx Lenses