New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/8/2025 12:52:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	1
OS	0.25

Date of visit:: 2/1/2025 12:52:00 PM
Cost:
Service:: Exam
prescribed by doctor:: Luna
Notes:: Double Check (Do Another Refraction if she comes back)

	SPH	CYL	AX	ADD
OD	1.25
OS		-1	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS