New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/4/2024 5:34:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Notes:
Dior frame + lenses
SPH
CYL
AX
ADD
OD
-1.25
OS
-2
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
Back to List