1 Order Form New fitting Company name: www.swisslens.ch Email [email protected] customer ID: SP3 Patient name: __________________________ SP12 } no refund SL3+ SL12+ } Urgent 2 free returns SN engraving Right lens marking Order number: ________________________________ Date: Surcharge see price list Signature: Measurments values for first fitting Refraction right sph cyl Axis left Add VA sph cyl Axis Add VA Delta 0 or ____ mm K’readings & Axis En(RGP) En(RGP) Cornea Ø (Iris Ø + 0.60 mm) Eyelid pressure low normal high low normal high Eyelid opening small normal big small normal big Upper eyelid pos. high normal low high normal low Lower eyelid pos. low normal high low normal high Sulcus/CSP flowing (-) Pupil Ø with small room lighting pronounced (+) normal Leading eye flowing (-) large small Far PC Near RGP contact lenses Spherical Spherical Orbis (Unifocal) Orbiflex (Unifocal) Relax (Myopie-Relaxing) Boriflex (Multifocal) Borelis (Multifocal) Geometry Toric Far SA 2 aspherical flattening S2A Relax-T (Myopie-Relaxing) 3 spherical flattening S3S Torelis (Multifocal) Multifocal design Dynamic Ext Dyn Simple progressive Dynamic Int Dyn Ballast Int Bal Toric Bifocal Bf Simple progressive Sp Multi progressive Mp Definitive (SiH74%) GM3 (58%) GM3 (49%) Igel (77%) Snoflex (68%) Contaflex (67%) Vistagel (64%) Igel (58%) Bf Sp blue white For reorders, please use our online tool. www.swisslens.ch Your SwissLens support virtual lens fitting (vlf) SwissLens offer an online order assistant (vlf). There you can add all your patients Toriflex Multifocal design Near Comments 1 aspherical flattening Bifocal PC For fittings of medical contact lenses (HydroCone, HydroMed, Prosthetic...) we need more informations. Please contact our customer care. +41 21 620 06 66 Toris (Unifocal) Stabilisation large left Soft contact lenses Materials normal right Vision priority pronounced (+) Bitoric BT Front-toric prismatic TP data and it will recommend the first trial lens. Virtual fluor images can be shown for RGP contact lens fittings. Materials blue green Optimum Classic Optimum Comfort Optimum Extra Paragon Thin Paragon HDS Boston EO Boston ES Dry exes Deposit resitant Breakage resitsant Highe oxygen permeability Extended wearing time Low dehydration purple Boston XO Material selection by SwissLens High compatibility and comfort Silicon hydrogel Spherical Orbiflex (Unifocal) Boriflex (Multifocal) Geometry 1 aspherical flattening SA 2 aspherical flattening S2A 3 spherical flattening S3S Multifocal design Bifocal Simple progressive Bf Sp Toric Toriflex Bitoric BT Front-toric prismatic TP