New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/25/2024 2:36:00 PM
Cost:: 15
Service:: Contact Lenses
prescribed by doctor:: OLD RX
Notes:: Clear 55 + Clear View Solution

	SPH	CYL	AX	ADD
OD	-2.25
OS	-2.25

Date of visit:: 5/5/2025 2:44:00 PM
Cost:: 20
Service:: Frame Only
prescribed by doctor:
Notes:: Dior Round

	SPH	CYL	AX	ADD
OD
OS

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS