New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/20/2025 1:24:00 PM
Cost:
30
Service:
Change Lenses
prescribed by doctor:
old rx
Notes:
AR
SPH
CYL
AX
ADD
OD
2.5
1
158
OS
2.25
1
175
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