New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/28/2025 1:52:00 PM
Cost:
30
Service:
Frame + Lenses
prescribed by doctor:
Old RX (Px Assured Us)
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
3.5
OS
3.5
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
Back to List