New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/1/2025 5:11:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Airlite, AR Transition

	SPH	CYL	AX	ADD
OD	0	-1	40
OS	0	-1.5	155

Date of visit:: 6/3/2025 10:36:00 AM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: OLD Rx
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	0	-1	40
OS	0	-1.5	155

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS