New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/20/2025 11:00:00 AM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
dr. Abbass Baydoon
Notes:
AR
SPH
CYL
AX
ADD
OD
2.5
0.75
85
OS
3
0.75
90
Date of visit:
2/5/2026 2:16:00 PM
Cost:
25
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR Lenses 60mm
SPH
CYL
AX
ADD
OD
2.5
0.75
85
OS
3
0.75
90
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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