New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/17/2025 1:25:00 PM
Cost:: 55
Service:: change frame
prescribed by doctor:
Notes:: same lenses(progressive lenses)

	SPH	CYL	AX	ADD
OD	1	0.5	100	2
OS	0.5	0.5	80

Date of visit:: 12/11/2025 4:18:00 PM
Cost:: 110
Service:: Frame+Lenses 2
prescribed by doctor:: Dr. Ali Alhaj
Notes:: AR

	SPH	CYL	AX	ADD
OD	0.75	0.5	90
OS	1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS