New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/26/2024 3:24:00 PM
Cost:: 90
Service:: Change Lenses
prescribed by doctor:: Old Rx
Notes:: Progressive Lenses PL cut at idol

	SPH	CYL	AX	ADD
OD	0.5	1.5	165	2.25
OS		0.75	15	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS