New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/13/2025 2:13:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Metal + AR Lenses 60mm

	SPH	CYL	AX	ADD
OD	3.25
OS	3.25

Date of visit:: 12/12/2025 2:35:00 PM
Cost:: 60
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	1.5
OS	1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS