NightFlex OrthoK Formulário de Reencomenda













    Fitting phaseReorder

    MorningEvening

    Night/s

    Month/s

    Overrefration without CL








    yesno

    Overrefraction with CL (important in poor visual acuity)





    Assessment




    01234

    noyes

    normaltoo difficult

    nonesmallLarge
    Upload pictures/file max. 3mb (JPG, PNG, U12, ZCS, ZIP)





    Fitting phaseReorder

    MorningEvening

    Night/s

    Month/s

    Overrefration without CL








    yesno

    Overrefraction with CL (important in poor visual acuity)





    Assessment




    01234

    noyes

    normaltoo difficult

    nonesmallLarge
    Upload pictures/file max. 3mb (JPG, PNG, U12, ZCS, ZIP)






    Por favor prove que é humano ao seleccionar Avião.

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