New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/13/2025 2:29:00 PM
Cost:: 35
Service:: change lenses
prescribed by doctor:: LUNA
Notes:: Antiblue, green coated change lenses for near only

	SPH	CYL	AX	ADD
OD	0.75	-0.75	95	1.25
OS	0.5	-0.75	80	1.25

Date of visit:: 2/13/2025 2:32:00 PM
Cost:: 110
Service:: Frame+Lenses
prescribed by doctor:: LUNA
Notes:: Antiblue, green coated change lenses for far

	SPH	CYL	AX	ADD
OD	0.75	-0.75	95	1.25
OS	0.5	-0.75	80	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS