New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/20/2025 1:24:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Shoker
Notes:: metalic Frame , progressive lenses freeform AR

	SPH	CYL	AX	ADD
OD	1			2
OS	1.25			2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS