Worksheet

Eyewear order form template

One page, four blocks. Block A has one row for each eye, with columns for sphere, cylinder, axis, add and PD, and a check column that flags a missing sign or axis. Block B holds the frame and its three measurements, and block C lists lens type, index and coatings beside a column for combinations the lab will not cut. Block D tracks upload, expiry and review.

Name: ______________________   Business: ______________________   Date: ______________

Scroll the table sideways to see every column.

Cross out or rewrite any heading that does not fit your business. From the guide “Prescription eyewear order form: what to capture at checkout”, www.gullysystem.com/blog/prescription-eyewear-order-form-what-to-capture-at-checkout