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Next line. Please list: city, 2-letter state abbreviation, and the ZIP+4 information on the next 3 lines. The patient's DAYTIME telephone number should be placed in this space below SSN and Rank. Please check the ship to patient box ONLY if special circumstances are described in the Comments section below. STATUS: Select the appropriate duty status for the member. The box may be selected by a Left mouse click on the box or by hitting the space bar when the box is selected. AD Active Duty; RES.

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Active Duty Service Members and Activated. Guard/Reserve Members. You can get glasses from the optometry clinic at your military hospital or clinic. If you don't live near a military hospital or clinic, you can order your glasses from the Navy Ophthalmic Readiness Activity Yorktown.

DD Form 771, "EYEWEAR PRESCRIPTION"

An example of an eyeglass prescription Here is a sample eyeglass prescription: OD -2.00 SPH +2.00 add 0.5 p.d. OS -1.00 -0.50 x 180 +2.00 add 0.5 p.d. In this case, the eye doctor has prescribed -2.00 D sphere for the correction of myopia in the right eye (OD).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232