New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/7/2024 5:26:00 PM
Cost:: 50
Service:: frame+lenses
prescribed by doctor:: 50
Notes:: AR

	SPH	CYL	AX	ADD
OD	-0.25
OS	0.25

Date of visit:: 8/21/2025 12:57:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	-0.5
OS	0	-0.25	25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS