New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/4/2025 4:09:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2.5	-1.5	90
OS	2.5	-1.5	84

Date of visit:: 2/3/2025 11:10:00 AM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: olive black, transition AR MODERN

	SPH	CYL	AX	ADD
OD	0.5	-1.5	90
OS	0.5	-1.5	84

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS