New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/6/2025 4:08:00 PM
Cost:
80
Service:
Frame + Lenses
prescribed by doctor:
OLD RX
Notes:
Flex' AR
SPH
CYL
AX
ADD
OD
-0.5
-0.25
170
OS
-0.25
-0.5
2
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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