New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/10/2025 2:08:00 PM
Cost:: 45
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Sketchers Frame + AR Lenses

	SPH	CYL	AX	ADD
OD		-0.5	110
OS	-0.25	-0.25	80

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS