New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/29/2025 11:32:00 AM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
Acetate AR1.61
SPH
CYL
AX
ADD
OD
3.5
-0.75
95
OS
3.25
-1.25
95
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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