If you have an electronic copy of your contact lens prescription in .JPG or .PDF format, simply upload it and we will do the rest. Once uploaded, skip to the
bottom of this page and click the "REGISTER" button.
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Your Name *
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Your Email *
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Confirm Email *
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Mobile Phone Number *
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Easy upload your contact lens prescription in .PDF or .JPG below
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If you do not have an electronic copy of your contact lens prescription, please enter the details below.
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Prescription issue date
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MM
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DD
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YYYY
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Prescription expiry date
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MM
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DD
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YYYY
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Prescribing Optometrist:
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RIGHT EYE
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Name of Lens:
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Base Curve:
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Diameter:
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Sphere:
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Cyl:
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Axis:
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Notes:
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If you can't find your lens on the list, type it here.
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LEFT EYE
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Name of Lens:
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Base Curve:
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Diameter:
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Sphere:
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Cyl:
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Axis:
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Notes:
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If you can't find your lens on the list, type it here.
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Acknowledgments:
I permit Noosa Optical to contact the prescribing optometrist to clarify details of my contact lens prescription if required. The contact lens prescription I
have uploaded or entered manually is current and accurate. I understand that as a contact lens wearer I should have regular eye examinations (at least yearly) and I have discussed and
understand the risks associated with contact lens wear with my usual optometrist.
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Please select one: *
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I agree
I disagree
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