INSTRUCTIONS FOR WEARERS
Patient Name
____________________________________________
Date Dispensed
____________________________________________
Dispensed Lens
Lens Type
Design
Daily Wear (DO NOT sleep in these lenses.)
Aspheric
Bifocal
Spherical
Material
Toric
Paraperm
®
O
2
Lens Prescription
Eye
Base Curve
Power
Diameter
Color
Lot Number
Right
Left
Prescribed By
Dr.
__________________________________________________
Address
__________________________________________________
__________________________________________________
Phone
__________________________________________________
My cleaning and disinfecting system is:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
