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VR RX LENSES
Online Form - VR Insert Rx Lenses
VR Rx Insert w/ Rx Lenses
(Take Advantage By Using Your Flex Spending or Health Savings Card)
Step #1: Promotion
*
Indicates required field
Interested in Our Special Promo (Package Price $149 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)
*
Parent/Gaurdian Name (If Patient Under 18)
*
First
Last
Phone Number
*
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??
*
Yes
No
(If "No'", Please enter billing information below)
Billing Information: (Street, City, State, Zip, and Country)
*
Step #4: Rx Information
Single Vision Price Ranges
Mild Rx: +3.00 to -3.00 |$168.00
Strong Rx: +3.25 or Higher | -3.25 or Higher
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:
Select Your Anti Reflective Coating (Highly Recommended)
- Optional Lens Add-On But
We Highly Recommend Anti Coating Regardless if it's Avance or Blue Light Blocker -
Which A/R Coating Tier are You Interested In?
*
A/R Coating (Basic Tier) $99 Extra
A/R Prevencia Coating w/ Blue Light Blocker (Top Tier) $199 Extra
Not Sure...
No Thanks, I'll Pass
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.
Step #6: Select a Color
Please Pick Your VR Insert Colors (Base and Top Adapters)
*
White
Red
Blue
Step #7 Select VR (Magnets) Orientation
- The VR Insert Can Be Inserted onto the Oculus Device Two Different Ways -
(We Prefer Magnets at the Top for Max Comfort) | If you click "Not Sure..." then we will recommend Magnets @ the Top
Disclaimer: If you have an Astigmatism (Cyl and Axis) on your Rx then by changing magnet orientation will effect your vision. Single Vision Spheres Only (Ex: +3.00 or -2.00) can use ANY orientation.
Pick Your Prefered Magnets Orientation
*
Magnets at the Top (Recommended Position)
Magnets at the Nasal (Nose)
Not Sure....
Magnets at the Top
Magnets at the Nasal
Step #8: Send Us a Facial Photo of the Patient (18-20 Inches Away)
This is for the PD (pupillary distance) Oculus Refers to IPD (
Inter Pupillary Distance
) which is the same thing
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
Submit Form By Clicking Button Below
Note: All fields with an
****
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 VR Rx Lenses
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VR RX LENSES
Online Form - VR Insert Rx Lenses