New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/20/2025 11:58:00 AM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.25	-0.25	115
OS	-0.5

Date of visit:: 1/14/2026 2:13:00 PM
Cost:: 35
Service:: change lenses
prescribed by doctor:: Nancy
Notes:: Antiblue Green coated

	SPH	CYL	AX	ADD
OD	-1.5	-0.75	140
OS	-0.5	-0.5	25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS