New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/3/2025 2:05:00 PM
Cost:: 70
Service:: 2 Frame + 2 Lenses
prescribed by doctor:: Dr. Ali Abed Al Hajj
Notes:: Airlite + AR Lenses and Olive + AR Lenses one for dist and one for Near

	SPH	CYL	AX	ADD
OD	-0.25	-1.5	90	2.25
OS	-0.25	-2	75	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