New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/25/2025 5:37:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	0	-1.25	20
OS	0.75	-0.75	160

Date of visit:: 1/31/2026 1:58:00 PM
Cost:: 35
Service:: frame +lenses
prescribed by doctor:: Old RX
Notes:: AR

	SPH	CYL	AX	ADD
OD	0	-1.25	25
OS	0.75	-0.75	160

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS