New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/27/2025 12:25:00 PM
Cost:
16
Service:
Contact Lenses
prescribed by doctor:
Old Rx
Notes:
Clear 55 + Versace Solution SPH Equivalent OD:-5.00 and OS:-4.00
SPH
CYL
AX
ADD
OD
-4.5
-1.25
5
OS
-3.5
-0.5
3
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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