Get Optical Order Form Template

This guide will help you navigate the Optical Order Form Template with ease. Follow the outlined steps to ensure accurate completion of the form for your optical order.

Follow the steps to successfully fill out the Optical Order Form Template.

1. Click ‘Get Form’ button to access the Optical Order Form Template and open it for editing.
2. Begin by entering your JAK account number in the designated field, ensuring it is accurate to avoid processing delays.
3. Input the provider's phone number, including the area code, to facilitate communication.
4. Write the provider's name clearly, followed by their National Provider Identifier (NPI) number.
5. Fill in the dispensing provider's address along with the city, state, and zip code.
6. Provide member information by entering the member ID number and name (last, first, initial) in the appropriate fields.
7. Fill out the member's address details, including street, city, state, and zip code.
8. Select the member's gender from the options provided.
9. For frame/prescription information, indicate the type of lenses, specifying if they are plastic or polycarbonate.
10. Record the date of birth using the format MMDDYYYY and the order date in the same format.
11. Complete the prescription details, including sphere, cylinder, axis, and other necessary measurements for both right (R) and left (L) eyes.
12. Describe the frame details including frame name, color, eye, bridge, and temple specifications.
13. If there are any special instructions or requests, write them in the designated space.
14. Once you have filled out all sections of the form, review the information for accuracy before saving changes.
15. You may then download, print, or share the form via email or fax as required by following the provided submission instructions.

Complete your Optical Order Form Template online today to streamline your optical ordering process.