New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/3/2024 7:25:00 PM
Cost:: 25
Service:: Toric Lenses "Saad"
prescribed by doctor:: Old RX
Notes:

	SPH	CYL	AX	ADD
OD	-3.5	1	100
OS	-3	0.75	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS