New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/18/2025 4:12:00 PM
Cost:: 45
Service:: frame +lenses
prescribed by doctor:: Nancy
Notes:: AR, lenses for near only and add is without astigmatism

	SPH	CYL	AX	ADD
OD	0.75	-0.5	70	1.5
OS	0.75			1.5

Date of visit:: 3/13/2025 3:46:00 PM
Cost:: 60
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: Airlite + AR Lenses for near

	SPH	CYL	AX	ADD
OD	2.25
OS	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS