Aziz Eye Care

Membership (Eye) Card

Complete the required details and upload a clear photograph.

Photo

Use a well-lit photo where your face is easy to recognize.

Name

WhatsApp No.

Right Eye (O.D.) - SPH

Sphere power for the right eye.

Right Eye (O.D.) - CYL

Cylinder power for the right eye.

Right Eye (O.D.) - AXIS

Axis, 0-180 degrees.

Right Eye (O.D.) - ADD

Left Eye (O.S.) - SPH

Sphere power for the left eye.

Left Eye (O.S.) - CYL

Cylinder power for the left eye.

Left Eye (O.S.) - AXIS

Axis, 0-180 degrees.

Left Eye (O.S.) - ADD

PD (Pupillary Distance)

Distance between the pupils, in millimetres.

Remarks

Prescription Expiry

Date this eye prescription expires.

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