New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/13/2025 11:25:00 AM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: dr. Ali Alhaj
Notes:: Antiblue transition

	SPH	CYL	AX	ADD
OD	-1.25
OS	-2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS