Prescription form

Submit your prescription.

Fill in your details and prescription, then continue to secure Shopify checkout. Our team reviews every order before production begins.

Frame selection

CategorySelected frame✓ Ready for checkout — $250 CAD

Customer information

First nameLast nameEmailPhone numberShipping addressCityProvince / StateCountryPostal code

Prescription uploadUpload Your PrescriptionAccepted formats: PDF, PNG, JPG, JPEG, or screenshot. Max 10MB. Our team will review your file before production.

Prescription details

Pupillary distance (PD)I don't know my PD

Prescription type

Lens options

Standard clear lensesAnti-glareBlue light filteringScratch resistantThinner lensesTransition lensesOther / special requestNot sure / need help

If you have a specific lens request, upgrade request, or are not sure what you need, please add it in the Additional Notes section below. Our team will review your prescription details before production.

Additional notes

I confirm the prescription information provided is accurate and current, and I authorize KYLIAN to produce my glasses based on it.I understand that prescription eyewear is custom-made and becomes final sale once production begins.

KYLIAN does not provide eye exams, medical advice, or vision prescriptions. Customers must provide a valid prescription from a licensed eye care professional. Questions? Contact support@kylian.ca.