Advertisement
APPOINTMENT SCHEDULE
Minimum number of hours lenses to be worn at time of appointment:
Your appointments are on:
Month
PATIENT/EYE CARE PRACTITIONER INFORMATION:
Eye Care Practitioner Information
Practitioner Name:
Practice Name:
Practitioner Address:
Practitioner Phone Number:
Recommended Lens Care Regimen:
Cleaning Solution:
Conditioning Solution:
Rewetting Solution:
Weekly Enzymatic Cleaner:
IMPORTANT: In the event that you experience any difficulty wearing your lenses or you do not understand
the instructions given you, DO NOT WAIT for your next appointment. TELEPHONE YOUR EYE CARE
PRACTITIONER IMMEDIATELY.
© Polymer Technology, a Bausch & Lomb company
1400 North Goodman Street
Rochester, NY 14609
1-800-333-4730
® denotes registered trademarks of Polymer Technology, a Bausch & Lomb company.
Print date: 1/04
Year
Time
Day
LB9197/06
Advertisement
