New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/12/2025 12:57:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Valentino Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	3
OS	3.25

Date of visit:: 9/13/2025 2:01:00 PM
Cost:: 15
Service:: Frame Only
prescribed by doctor:
Notes:: Acetate Reading

	SPH	CYL	AX	ADD
OD
OS

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS