New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/8/2024 2:37:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
RX
Notes:
Oliver Peoples +TRANSITION LENSES
SPH
CYL
AX
ADD
OD
-4.5
-0.25
110
OS
-4.5
-0.75
85
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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