New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/27/2023 6:21:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-1.5			2
OS	0.25			2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS