New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/2/2025 6:53:00 PM
Cost:
160
Service:
Frame + Lenses
prescribed by doctor:
OLD RX
Notes:
Safilo Frame + 1.75 AR Lenses
SPH
CYL
AX
ADD
OD
-5.25
-2
10
OS
-7
-1.25
85
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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