New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/10/2025 1:00:00 PM
Cost:
25
Service:
Change Lenses
prescribed by doctor:
Dr. Nizar Salloukh
Notes:
AR Lenses FOR NEAR
SPH
CYL
AX
ADD
OD
1.25
0.5
175
2
OS
1.5
2
Date of visit:
3/2/2025 11:14:00 AM
Cost:
40
Service:
Frame+Lenses
prescribed by doctor:
Dr. Nizar Salloukh
Notes:
AR for near
SPH
CYL
AX
ADD
OD
1.25
0.5
175
2
OS
1.5
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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