New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/15/2025 11:58:00 AM
Cost:
100
Service:
1 New Oliver Peoples Frame + Change Lenses for Near
prescribed by doctor:
Nancy
Notes:
AR For BOTH
SPH
CYL
AX
ADD
OD
1.25
2
OS
1.5
-0.5
90
2
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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