New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/22/2025 3:36:00 PM
Cost:: 25
Service:: Change Lenses
prescribed by doctor:: Nancy
Notes:: Mother said he has 2.25 both eyes , we did what she asked

	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