New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/2/2024 6:08:00 PM
Cost:: 75
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: AR 1.67 + TOOK 25$ FRAME

	SPH	CYL	AX	ADD
OD	-9
OS	-8

Date of visit:: 4/24/2025 6:50:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: OLD RX
Notes:: Polyview

	SPH	CYL	AX	ADD
OD	-8
OS	-8

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS