New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/14/2025 2:46:00 PM
Cost:: 80
Service:: 2 Frame + 2 Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses for both

	SPH	CYL	AX	ADD
OD	0	-0.75	170
OS	-0.25	-0.5	175

Date of visit:: 1/3/2026 2:05:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: 40
Notes:: AR

	SPH	CYL	AX	ADD
OD		-0.5	167
OS	-0.5	-0.25	3

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS