New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/7/2025 1:49:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Tiffany & Co + Transition + AR W9 (The frame is for his wife)

	SPH	CYL	AX	ADD
OD	-0.75	-1.75	160
OS	-1.25	-0.75	25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS