New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/20/2025 1:54:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	1
OS	1.25

Date of visit:: 1/20/2025 2:11:00 PM
Cost:: 20
Service:: change lenses
prescribed by doctor:: nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	3.25
OS	3.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS