New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/30/2024 12:53:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Alame
Notes:: AR Transition (TOM FORD METAL)

	SPH	CYL	AX	ADD
OD	-1.75	-2	95
OS	-0.25	-0.25	70

Date of visit:: 6/15/2024 11:55:00 AM
Cost:: 0
Service:: Eye Exam
prescribed by doctor:: Aya
Notes:

	SPH	CYL	AX	ADD
OD	-1.75	-1.25	95
OS	-0.25	-0.25	70

Date of visit:: 7/1/2024 7:12:00 PM
Cost:: 40
Service:: change lenses
prescribed by doctor:: Aya
Notes:: Transtion AR

	SPH	CYL	AX	ADD
OD	-1.75	-1.25	95
OS	-0.25	-0.25	70

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS