New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/15/2025 11:09:00 AM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: nancy
Notes:: Raybun metalic frame AR Lenses

	SPH	CYL	AX	ADD
OD	-0.75	-0.75	85
OS	-0.75	-0.5	75

Date of visit:: 2/13/2026 4:22:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Metal Frame + Lenses

	SPH	CYL	AX	ADD
OD	-0.75	-1	85
OS	-0.75	-0.75	75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS