New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/18/2025 12:07:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: old rx
Notes:: AR

	SPH	CYL	AX	ADD
OD	-4.25	-0.5	8
OS	-3.75	-1	14

Date of visit:: 4/18/2025 12:12:00 PM
Cost:: 25
Service:: Contact Lenses
prescribed by doctor:
Notes:: cinnamon brown

	SPH	CYL	AX	ADD
OD	-4.5
OS	-4.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS