New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/2/2024 10:56:00 AM
Cost:: 65
Service:: Frame + Lenses
prescribed by doctor:: nancy
Notes:: anti-blue green coated + Metal

	SPH	CYL	AX	ADD
OD	-3.25
OS	-3.5

Date of visit:: 2/4/2026 3:25:00 PM
Cost:: 75
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: Antiblue 1.61

	SPH	CYL	AX	ADD
OD	-4
OS	-4

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS