New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/21/2024 3:35:00 PM
Cost:: 80
Service:: Flex+ transtion lenses
prescribed by doctor:: Aya
Notes:

	SPH	CYL	AX	ADD
OD	-0.25	-1	50
OS	-0.25	-0.25	150

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS