New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/1/2025 4:41:00 PM
Cost:
50
Service:
2 Frames + 2 Lenses
prescribed by doctor:
Nancy
Notes:
AR Lenses ONE for Dist ONE for Near
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
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