New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/1/2025 10:37:00 AM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR

	SPH	CYL	AX	ADD
OD	-3.25	-0.25	150
OS	-3	-0.75	18

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	-3.5
OS	-3.75

Date of visit:: 11/7/2025 4:21:00 PM
Cost:: 8
Service:
prescribed by doctor:
Notes:

	SPH	CYL	AX	ADD
OD
OS

Date of visit:: 11/7/2025 4:21:00 PM
Cost:: 8
Service:
prescribed by doctor:
Notes:

	SPH	CYL	AX	ADD
OD
OS

Date of visit:: 11/7/2025 4:21:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: Old RX
Notes:: PV + Versace

	SPH	CYL	AX	ADD
OD	-3.5
OS	-3.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS