Partner with LENSRXLAB: DIAVISTA Voucher Pilot Program

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SERVICE@LENSRXLAB.COM

Join Us in Transforming millions of Lives Yearly with Diabetic Eyewear: Our Vision, Your Clarity, Our Ongoing Commitment

million+: LENSRXLAB goal to impact annually individuals with diabetes using DiaVista All-In-One Diabetic Eyewear Packages

million people worldwide have diabetes

million+: LENSRXLAB goal to empower annually individuals with diabetes using DiaVista Advanced Diabetic Lens Technology

ORGANIZATION INFORMATION

Organization Name

Your Email Address

Contact First Name

Contact Last Name

Phone Number

Organizations Website URL

City

State

Street

Zip Code

SUBSIDY: “Low Income Individuals”, “Veterans”, “Seniors”, and “College Students”

Organization Committed Subsidy [Enter Committed Subsidy $ Amount Below; Minimum Committed Subsidy = $15,000; Minimum Committed Subsidy for Branded Gift Voucher Card = $43,750]

Brief Description of Organization and Mission

How Did You Hear About the DIAVISTA Gift Voucher Pilot Program?

Target Diabetic Population for Gift Vouchers (check all that apply)

Low-Income Children Low-Income Women Low-Income Men Veterans Seniors College Students Other

Organization Type (Drop Down)

FULLY SUBSIDIZED PRESCRIPTION DIABETIC EYEWEAR PACKAGES COVERED BY VOUCHERS

All-In-One Diabetic Eyewear Package Types (Check all that apply):

Eyeglasses Sunglasses Readers/computer glasses Men’s Women’s Girl’s Boy’s

Prescription:

Single Vision
Bifocal
Progressive

Lens Material:

Polycarbonate

DiaVista Lens Type:

DiaVista Premium Polarized/Transition with UV + IR blocking
DiaVista Super Premium Polarized/Transition with UV + IR blocking

Lens Coatings:

Oleophobic/Hydrophobic (Smudge Armor Guard)
Multi-Layered Mirror Coating (Reflect Shield Glam)
Hard Coating (Scratch Armor Shield)
UV Film (Sun Guard Shield)
Super Premium Nirtech® Coating (Clarity Guard Tech)
Polarized Anti-Glare Film (Glare Guard Tech)
Anti-Reflective Coating (Clear View Shield)
Anti-Fog Coating (Fog-Free Shield)

Transition Colors:

Gray
Gray Mirror
Blue Mirror
Amber (aka Brown)
Amber Silver Mirror
Amber Green Mirror
Light Blue Mirror
Rose
Chartreuse
Chartreuse Mirror
Computer Lens

Subsidies:

LENSRXLAB 40% Founders Subsidy

Other All-In-One Rx Diabetic Package Features:

Box
Protective Case
Soft Bag
Cleaning Kit (cleaner and cloth)
Free Basic Shipping - applies to the contiguous 48 U.S. States–Alaska, Hawaii, and U.S. territories (Puerto Rico, Guam, Northern Mariana Islands, U.S. Virgin Islands and American Samoa)
Frame Warranty for one year against defects in material and workmanship

UNITE FOR VISION, TOGETHER IN COMMUNITY

Join forces with LENSRXLAB to integrate groundbreaking RX eyewear solutions, enhancing care and outcomes for patients, beneficiaries, and program participants alike. Together, let’s revolutionize vision care and improve lives.

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