New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/10/2025 4:59:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	2.75
OS	2.75

Date of visit:: 5/28/2025 5:03:00 PM
Cost:: 20
Service:: change lenses
prescribed by doctor:: OLD Rx
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2.75
OS	2.75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS