New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/2/2025 2:01:00 PM
Cost:
80
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
progressive lens (US design) FMC
SPH
CYL
AX
ADD
OD
2.25
1
70
2.25
OS
1.75
1
85
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
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