New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/30/2024 6:26:00 PM
Cost:: 80
Service:: Frame NEW Airlite --> without lenses (NEW Dior + Lenses)
prescribed by doctor:
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.25	-0.75	30
OS	-1.25	-0.75	155

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS