New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/17/2025 4:30:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: OLD RX
Notes:: Hugo boss+AR transition

	SPH	CYL	AX	ADD
OD	-0.5	-2.5	160
OS	-1.75	-0.5	30

Date of visit:: 1/7/2026 4:58:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:
Notes:: contact lenses

	SPH	CYL	AX	ADD
OD	-0.5	-2.5	164
OS	-1.75	-0.5	21

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS