New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/20/2025 1:11:00 PM
Cost:: 100
Service:: 2Frame + Lenses
prescribed by doctor:: luna
Notes:: single vision for far and for near both trench

	SPH	CYL	AX	ADD
OD	1.75			2.25
OS	1.75			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