New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/14/2024 11:03:00 AM
Cost:: 15
Service:: Change lenses AR
prescribed by doctor:: OLD RX
Notes:

	SPH	CYL	AX	ADD
OD		-2.5	90
OS		-2.5	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS