New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/30/2025 5:44:00 PM
Cost:: 80
Service:: 2 Frames + 2 Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses ONE for Dist ONE for Near

	SPH	CYL	AX	ADD
OD	0.75	-0.75	100	1.5
OS	0.25			1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS