Myday® Multifocal 90 Pack

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Last Name *

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Who is the prescription for?

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Last Name *

Date of Birth *

When was the prescription issued?

Date of Prescription *

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Prescription information

Who is the prescription for?

First Name *

Last Name *

Date of Birth *

When was the prescription issued?

Date of Prescription *

Enter prescription details

Same prescription for both eyes?

Right Eye
Basecurve *
- -
- 8.5
- 9.0
Diameter *
- -
- 14.3
Sphere *
- -12.00
- -11.50
- -11.00
- -10.50
- -10.00
- -9.50
- -9.00
- -8.50
- -8.00
- -7.50
- -7.00
- -6.50
- -6.00
- -5.75
- -5.50
- -5.25
- -5.00
- -4.75
- -4.50
- -4.25
- -4.00
- -3.75
- -3.50
- -3.25
- -3.00
- -2.75
- -2.50
- -2.25
- -2.00
- -1.75
- -1.50
- -1.25
- -1.00
- -0.75
- -0.50
- -
- +0.50
- +0.75
- +1.00
- +1.25
- +1.50
- +1.75
- +2.00
- +2.25
- +2.50
- +2.75
- +3.00
- +3.25
- +3.50
- +3.75
- +4.00
- +4.25
- +4.50
- +4.75
- +5.00
- +5.25
- +5.50
- +5.75
- +6.00
- +6.50
- +7.00
- +7.50
- +8.00
Left Eye
Basecurve *
- -
- 8.5
- 9.0
Diameter *
- -
- 14.3
Sphere *
- -12.00
- -11.50
- -11.00
- -10.50
- -10.00
- -9.50
- -9.00
- -8.50
- -8.00
- -7.50
- -7.00
- -6.50
- -6.00
- -5.75
- -5.50
- -5.25
- -5.00
- -4.75
- -4.50
- -4.25
- -4.00
- -3.75
- -3.50
- -3.25
- -3.00
- -2.75
- -2.50
- -2.25
- -2.00
- -1.75
- -1.50
- -1.25
- -1.00
- -0.75
- -0.50
- -
- +0.50
- +0.75
- +1.00
- +1.25
- +1.50
- +1.75
- +2.00
- +2.25
- +2.50
- +2.75
- +3.00
- +3.25
- +3.50
- +3.75
- +4.00
- +4.25
- +4.50
- +4.75
- +5.00
- +5.25
- +5.50
- +5.75
- +6.00
- +6.50
- +7.00
- +7.50
- +8.00

Prescription information

Who is the prescription for?

First Name *

Last Name *

Date of Birth *

When was the prescription issued?

Date of Prescription *

We need to verify your prescription

Enter your doctor's details

Doctor's Name *

Doctor's Phone *

Doctor's Email

Doctor's Fax

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TYPE

BRANDS

INFO

TYPE

BRANDS

INFO

Myday® Multifocal 90 Pack

CooperVision

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Who is the prescription for?

When was the prescription issued?

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Prescription information

Who is the prescription for?

When was the prescription issued?

Enter prescription details

Prescription information

Who is the prescription for?

When was the prescription issued?

We need to verify your prescription

Enter your doctor's details

Myday® Multifocal 90 Pack

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