New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/3/2025 5:09:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Airlite , AR Modern 1.67 both eyes

	SPH	CYL	AX	ADD
OD	-5.25	-1.5	25
OS	-4	-3	150

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS