New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/9/2025 5:27:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: OLD RX
Notes:: Iris + AR Transition

	SPH	CYL	AX	ADD
OD	-1.75	-2	95
OS	-2.5	-1.75	70

Date of visit:: 10/7/2025 4:48:00 PM
Cost:: 90
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: AR Transition W9

	SPH	CYL	AX	ADD
OD	-1.75	-2	95
OS	-2.5	-1.75	70

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS