New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/8/2025 2:44:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Rolling + AR + Transition

	SPH	CYL	AX	ADD
OD		-0.25	180
OS		-0.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS