New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/16/2025 10:29:00 AM
Cost:
30
Service:
Frame + Lenses
prescribed by doctor:
luna
Notes:
AR
SPH
CYL
AX
ADD
OD
1.75
-1.5
85
OS
0.75
-1
102
Date of visit:
9/24/2025 2:52:00 PM
Cost:
15
Service:
Change Lenses
prescribed by doctor:
OLD RX
Notes:
AR
SPH
CYL
AX
ADD
OD
1.75
-1.5
85
OS
0.75
-1
102
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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