New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/24/2024 1:17:00 PM
Cost:: 25
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR (captain)

	SPH	CYL	AX	ADD
OD	-4.25
OS	-4

Date of visit:: 2/8/2025 12:58:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: Sport Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	-4.25
OS	-4

Date of visit:: 5/19/2025 3:04:00 PM
Cost:: 35
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: AR

	SPH	CYL	AX	ADD
OD	-4.25
OS	-4

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS