New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/18/2025 1:37:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Metal Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	1.25
OS	1.25

Date of visit:: 4/19/2025 3:12:00 PM
Cost:: 25
Service:: change lenses
prescribed by doctor:: OLD Rx
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2.25
OS	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS