New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/3/2025 2:26:00 PM
Cost:: 30
Service:: Contact Lenses
prescribed by doctor:: Dr. Prescription
Notes:: Polyview Toric for OD normal for OS

	SPH	CYL	AX	ADD
OD	4.5	1.25	105
OS	3.5

Date of visit:: 5/3/2025 2:28:00 PM
Cost:
Service:
prescribed by doctor:
Notes:: She Took EyeDia Solution

	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