New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/12/2025 4:44:00 PM
Cost:
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	-2.5
OS	-2

Date of visit:: 9/12/2025 11:54:00 AM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: Airlite + New AR Lenses and last visit in may mother paid 35$

	SPH	CYL	AX	ADD
OD	-2.5
OS	-2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS