New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/12/2025 6:29:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Balenciaga Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	-3.25	-0.5	175
OS	-3.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS