New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/26/2024 2:10:00 PM
Cost:: 75
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: took glasses then came back to exchange the frame so we did and changed a pair of new trans lenses for free to fit the new frame

	SPH	CYL	AX	ADD
OD		-0.75	105
OS		-0.75	95

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS