New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/3/2024 1:10:00 PM
Cost:: 250
Service:: Frame + Lenses
prescribed by doctor:: Canada
Notes:: Oliver Peoples CRAZY FRAME +TRANSITION LENSES + compact (Proggressive)

	SPH	CYL	AX	ADD
OD	-0.5	-0.25	30	2.25
OS	-0.25	-1	137	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS