New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/1/2024 4:53:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: RX
Notes:: OLD degrees + NEW FRAME + NEW LENSES

	SPH	CYL	AX	ADD
OD	-0.5	-2	45
OS	-0.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS