New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/17/2024 12:15:00 PM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Cat Eye + AR 1.61
SPH
CYL
AX
ADD
OD
-2.5
-0.25
80
OS
-2.75
-0.25
75
Date of visit:
11/1/2025 3:45:00 PM
Cost:
60
Service:
Frame+Lenses
prescribed by doctor:
Nancy
Notes:
AR 1.61
SPH
CYL
AX
ADD
OD
-3.5
-0.25
80
OS
-3.75
-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
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