"fashion, quality, value"
guaranteed
For quote on fitting lenses to your frames, please fill in the forms and email to
service@opticaldirect.com.au
Your prescription
Sphere
Cylinder
Axis
Near Add
Int. Add
Prism
PD
Age
RIGHT(O.D.)
LEFT (O.S.)
Frame and lens Information (Please make selection by placing a √ beside the box )
Frame 1
Frame
Category
Frame 2
Eye glasses
prescription Sunglasses Frame
(Please provide a photo that shows the
front curve of the frame)
Frame Type
Full Rim
Nylon Frame (has groove around the
edge of the lens, eg. semi-rimless
frame, thin metal frame, please provide
a photo if not sure)
Rimless
Frame Dimension
Lens width
Lens width and bridge width are
(mm)
usually printed on the arm or at the
Bridge width
back of the nose bridge with a small
(mm)
square in between. Lens depth is the
Len depth
maximum vertical distance from the
(mm)
top of the lens (not the frame) to the
bottom of the lens in millimetres.
Please measure lens depth with a
ruler.
Lens Type
Single Vision Near
Information on lens types
can be found here
Lens Features
Information on lens
features can be found
here
Single Vision Distance
Bifocal lenses
(Lens Depth >26mm)
Computer lenses
(Lens Depth >26mm)
Multifocal lenses
(Lens Depth >24mm)
Anti-reflective coating
UV protection
Tinted
polarised
photochromic
Drivewear
URL of the frame if available
Jim Z Enterprises Pty Ltd
ABN: 78 110 971 778
PO Box 2386
Moorabbin
VIC 3189
Australia
Email: Service@opticaldirect.com.au
Fax: 0061-3-95897124
Frame 3
"fashion, quality, value"
guaranteed
Payment Method Preferred: Visa, Mastercard,
Paypal or Direct Fund Transfer?
Name of Health Fund*
*From 2014 Medibank Private and its subsidiary company Australian Health Management
(ahm) have placed restriction on types of the lenses and range of prescription you can
order from an online provider. They will not provide benefit for prescription lenses
purchased online that are:
1) Multifocal or Bifocal lenses
2) or with script greater than +/- 3.0
3) or orders for children under the age of 16.
Members of Medibank Private and ahm are encouraged to contact your health funds about
your entitlements before filling in the form. Our provider number for Medibank Private is
1474141F.
There is no such limitation from other health funds.
Jim Z Enterprises Pty Ltd
ABN: 78 110 971 778
PO Box 2386
Moorabbin
VIC 3189
Australia
Email: Service@opticaldirect.com.au
Fax: 0061-3-95897124