Please enter your eyewear prescription information. If you have a pdf or image file of your prescription, please submit it in the file box above and you do not have to fill out the rest of the form. If you do not have a PDF or image of your prescription saved, please enter your information manually below. If you would like to give us permission to get your prescription from your physician, please visit this page: https://www.monroesfootwearsupply.com/consent-of-release-of-medical-records-to-monroe-optical-inc/