New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/4/2024 2:09:00 PM
Cost:: 100
Service:: new frame +lenses
prescribed by doctor:: Moussa Bassam
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-2
OS	-1.5

Date of visit:: 9/12/2024 5:00:00 PM
Cost:: 35
Service:: Frame Only + Contact Lenses
prescribed by doctor:: Old RX
Notes:: Clear 55

	SPH	CYL	AX	ADD
OD	-2
OS	-1.5

Date of visit:: 1/28/2025 6:38:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Airlite + Lenses ANTI-BLUE GREEN COATED

	SPH	CYL	AX	ADD
OD	-2
OS	-1.5

Date of visit:: 1/28/2025 3:54:00 PM
Cost:: 120
Service:: Frame + Lenses
prescribed by doctor:: LUNA
Notes:: AR TRANSITION W9

	SPH	CYL	AX	ADD
OD	-2
OS	-1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS