New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/30/2025 4:58:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR lenses transition brown

	SPH	CYL	AX	ADD
OD	-0.25
OS	-0.25

Date of visit:: 6/24/2026 5:13:00 PM
Cost:: 20
Service:: Contact Lenses
prescribed by doctor:
Notes:: BELLA NAY PLANO

	SPH	CYL	AX	ADD
OD
OS

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS