New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/20/2025 2:15:00 PM
Cost:: 70
Service:: 2frames + 2 lenses
prescribed by doctor:: Nancy
Notes:: AR transition for far, AR for near ... for near without astigmatism

	SPH	CYL	AX	ADD
OD	0.5			1.25
OS	0	-0.75	60	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS