New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/23/2024 4:40:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alameh
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-2.5
OS	-2.5

Date of visit:: 10/4/2025 4:36:00 PM
Cost:: 15
Service:: Contact lenses + Solution
prescribed by doctor:: Luna
Notes:: Clear 55 + Versace

	SPH	CYL	AX	ADD
OD	-3
OS	-3

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS