New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/21/2025 11:46:00 AM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Shoker
Notes:: old frame for far (change lenses AR TRANSITION ) and one new frame for near ( AR)

	SPH	CYL	AX	ADD
OD	0	-1.25	108	1.5
OS	0	-1	63	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS