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  • Il Health Alliance Jak Optical Laboratories Eyeglass Order Form 2019

Get Il Health Alliance Jak Optical Laboratories Eyeglass Order Form 2019-2025

Eyeglass Order Form PO Box 3333 Peoria, IL 616123333 Fax 18003221822 Scan and email to lab jakopticallaboraties.comJAK Optical Laboratories JAK Account #Please Print or TypeProvider Phone #Provider.

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How to fill out the IL Health Alliance JAK Optical Laboratories Eyeglass Order Form online

Completing the IL Health Alliance JAK Optical Laboratories Eyeglass Order Form online can streamline the process of ordering eyeglasses. This guide provides clear, step-by-step instructions to help users navigate each section of the form effectively.

Follow the steps to complete your eyeglass order form.

  1. Press the ‘Get Form’ button to acquire the form and open it for completion.
  2. Begin by entering your JAK account number in the designated field at the top of the form.
  3. Fill in the provider's contact information, including the provider name, phone number, and address in the appropriate sections.
  4. Enter the member identification number related to your health plan under the 'IL Member Identification Number' section.
  5. Complete the patient information area by providing the first name, last name, gender, and date of birth.
  6. Specify the lens type by selecting options in the 'Lens Base' section, including plastic or polycarbonate, which is available for specific age groups and prescriptions.
  7. Provide details for the prescription by filling out the fields for sphere, cylinder, axis, decentration, and prism specifications.
  8. Complete the pupillary distance (PD) measurements for both right and left eye, including far and near positions.
  9. If applicable, note the date of order and any special instructions related to the eyeglass order.
  10. Upon completing all fields, you can save your changes, download the completed form, or print it directly.

Get started on filling out your eyeglass order form online today!

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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