New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/15/2025 11:12:00 AM
Cost:: 45
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR for near, Marchioni Nylor

	SPH	CYL	AX	ADD
OD	3.75	-0.25	105
OS	2	-0.25	78

Date of visit:: 3/15/2025 11:14:00 AM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR polycarbonate, olive

	SPH	CYL	AX	ADD
OD	1.25	-0.25	105
OS	-0.5	-0.25	78

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS