New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/22/2025 4:32:00 PM
Cost:
75
Service:
Frame Only
prescribed by doctor:
OLD RX (old lenses on new frame)
Notes:
Luna did an accurate examination
SPH
CYL
AX
ADD
OD
1.5
-2
85
2
OS
1.5
-0.75
80
2
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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