New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/23/2024 6:21:00 PM
Cost:: 25
Service:: Change Lenses
prescribed by doctor:: Nancy
Notes:: AR Compact

	SPH	CYL	AX	ADD
OD	4.5
OS	4.5

Date of visit:: 3/27/2025 2:52:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Nancy
Notes:: AR for Distance

	SPH	CYL	AX	ADD
OD	3
OS	2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS