New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/28/2025 4:12:00 PM
Cost:
100
Service:
1 Sunglasses + 1 Change Lenses
prescribed by doctor:
Old RX
Notes:
Sunglasses that were made into Dioptric + Transition and Change lenses for her RX
SPH
CYL
AX
ADD
OD
2.5
OS
2.5
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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