New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/11/2024 2:08:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: Aya
Notes:: PolyView

	SPH	CYL	AX	ADD
OD	-1.25
OS	-3.25

Date of visit:: 7/12/2025 2:23:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Bulgari Frame + AR compact lenses

	SPH	CYL	AX	ADD
OD	-1.5	-0.5	5
OS	-3.25	-0.5	180

Date of visit:: 7/12/2025 2:23:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Bulgari Frame + AR compact lenses

	SPH	CYL	AX	ADD
OD	-1.5	-0.5	5
OS	-3.25	-0.5	180

Date of visit:: 7/12/2025 12:05:00 PM
Cost:: 70
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR COMPACTED

	SPH	CYL	AX	ADD
OD	-1.5	-0.5	5
OS	-3.25	-0.5	180

Date of visit:: 5/29/2026 5:25:00 PM
Cost:: 80
Service:: Contact Lenses
prescribed by doctor:: OLD Rx
Notes:: 2 BOXES 1 DAY ACUVUE DEFINE (Color: Radiant Brown) with degrees each box is 40$

	SPH	CYL	AX	ADD
OD	-1.5
OS	-3

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS