New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/4/2024 11:27:00 AM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	-1.25	-1	170
OS	-1	-1.25	10

Date of visit:: 4/10/2025 11:29:00 AM
Cost:: 30
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.25	-1	170
OS	-1	-1.25	10

Date of visit:: 5/10/2025 2:12:00 PM
Cost:: 30
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.25	-1	170
OS	-1	-1.25	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS