Eye Care Provider Information for Complex Prescriptions

  • Please fill out the form below. Axon Optics will contact your eye care provider to see if they can place an order for your complex prescription in Axon Spectrashield Lenses. We will contact you after we speak with your eye care provider.
  • Patient Information

  • For verification purposes only.
  • Eyecare Provider Information

  • I agree that Axon Optics can contact my eye care provider on my behalf to determine if Axon Lenses can be made in my prescription.